Provider Demographics
NPI:1346491867
Name:SITE VISION CENTER
Entity Type:Organization
Organization Name:SITE VISION CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:DR
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:J
Authorized Official - Last Name:GIANFRIDDO
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:217-228-2060
Mailing Address - Street 1:3236 BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:IL
Mailing Address - Zip Code:62301-3712
Mailing Address - Country:US
Mailing Address - Phone:217-228-2060
Mailing Address - Fax:217-228-2066
Practice Address - Street 1:3236 BROADWAY ST
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:IL
Practice Address - Zip Code:62301-3712
Practice Address - Country:US
Practice Address - Phone:217-228-2060
Practice Address - Fax:217-228-2066
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-02
Last Update Date:2008-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0326000001OtherDME SUPPLIER ID
IL0326000001OtherDME SUPPLIER ID