Provider Demographics
NPI:1619290970
Name:PROGRESSIVE VISION CENTER, LTD.
Entity Type:Organization
Organization Name:PROGRESSIVE VISION CENTER, LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:C
Authorized Official - Last Name:BOBELL
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:309-647-2020
Mailing Address - Street 1:42 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:IL
Mailing Address - Zip Code:61520-2623
Mailing Address - Country:US
Mailing Address - Phone:309-647-2020
Mailing Address - Fax:309-647-8944
Practice Address - Street 1:42 N MAIN ST
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:IL
Practice Address - Zip Code:61520-2623
Practice Address - Country:US
Practice Address - Phone:309-647-2020
Practice Address - Fax:309-647-8944
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-01
Last Update Date:2010-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL6337240001Medicare NSC
ILIL3142Medicare PIN