Provider Demographics
NPI:1508865643
Name:MARION EYE CENTERS LTD.
Entity Type:Organization
Organization Name:MARION EYE CENTERS LTD.
Other - Org Name:MARION EYE CENTERS, LTD.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MAQBOOL
Authorized Official - Middle Name:
Authorized Official - Last Name:AHMAD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:618-993-3838
Mailing Address - Street 1:1200 W DEYOUNG ST
Mailing Address - Street 2:P.O. BOX 1178
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:618-997-5505
Practice Address - Street 1:1200 W DEYOUNG ST
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:IL
Practice Address - Zip Code:62959-4437
Practice Address - Country:US
Practice Address - Phone:618-993-5686
Practice Address - Fax:618-997-5595
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-20
Last Update Date:2017-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-051996152W00000X, 207W00000X
IL036.051996207WX0107X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
No152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
No207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina SpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
791580195OtherMEDICARE RAILROAD
ILCA2196 GROUP PTANOtherMEDICARE RAILROAD
IL036051996Medicaid
MO203169800Medicaid
IL0814870001Medicare NSC
ILP12420Medicare PIN
IL790860Medicare PIN
IL036051996Medicaid
791580195OtherMEDICARE RAILROAD
IL790861Medicare PIN
ILC51321Medicare UPIN
MO000004665Medicare PIN