Provider Demographics
NPI:1508063843
Name:SCHWENGEL, EMILY (OD)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:SCHWENGEL
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:EMILY
Other - Middle Name:
Other - Last Name:SEELMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:1200 W DEYOUNG ST
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:IL
Mailing Address - Zip Code:62959-4437
Mailing Address - Country:US
Mailing Address - Phone:618-993-5686
Mailing Address - Fax:618-997-6250
Practice Address - Street 1:821 S WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:DU QUOIN
Practice Address - State:IL
Practice Address - Zip Code:62832-1909
Practice Address - Country:US
Practice Address - Phone:618-542-3812
Practice Address - Fax:618-542-3953
Is Sole Proprietor?:No
Enumeration Date:2007-06-29
Last Update Date:2008-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046-009978152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0814870007OtherMEDICARE NSC NUMBER
IL9978OtherEYEMED
IL046009978Medicaid
IL0814870018OtherMEDICARE NSC NUMBER
ILP00418704OtherMEDICARE RAILROAD
IL0814870027OtherMEDICARE NSC NUMBER
134812OtherHEALTH ALLIANCE
IL0814870024OtherMEDICARE NSC NUMBER
IL046009978Medicaid