Provider Demographics
NPI:1518105121
Name:IMLER VISION CENTERS, LLC
Entity Type:Organization
Organization Name:IMLER VISION CENTERS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:IMLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:815-973-5043
Mailing Address - Street 1:1875 WILDCAT CT
Mailing Address - Street 2:
Mailing Address - City:DIXON
Mailing Address - State:IL
Mailing Address - Zip Code:61021-9244
Mailing Address - Country:US
Mailing Address - Phone:815-284-9749
Mailing Address - Fax:
Practice Address - Street 1:4857 MANHATTAN DR
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61108-2265
Practice Address - Country:US
Practice Address - Phone:815-399-0599
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-04
Last Update Date:2009-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-107453332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
6213290001Medicare NSC