Provider Demographics
NPI:1639277940
Name:FISHER-SWALE-NICHOLSON EYE CENTER SC
Entity Type:Organization
Organization Name:FISHER-SWALE-NICHOLSON EYE CENTER SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:TAMMY
Authorized Official - Middle Name:A
Authorized Official - Last Name:WILHOYT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:815-932-2020
Mailing Address - Street 1:352 BROWN BLVD
Mailing Address - Street 2:
Mailing Address - City:BOURBONNAIS
Mailing Address - State:IL
Mailing Address - Zip Code:60914-2458
Mailing Address - Country:US
Mailing Address - Phone:815-932-2020
Mailing Address - Fax:815-937-0060
Practice Address - Street 1:352 BROWN BLVD
Practice Address - Street 2:
Practice Address - City:BOURBONNAIS
Practice Address - State:IL
Practice Address - Zip Code:60914-2458
Practice Address - Country:US
Practice Address - Phone:815-932-2020
Practice Address - Fax:815-937-0060
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2014-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0464860001Medicare NSC
IL947330Medicare PIN