Provider Demographics
NPI:1760497598
Name:SPRINGFIELD EYE CONSULTANTS PC
Entity Type:Organization
Organization Name:SPRINGFIELD EYE CONSULTANTS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:LOWENTHAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:217-544-2020
Mailing Address - Street 1:301 N. 8TH ST.
Mailing Address - Street 2:SUITE 6B-201
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62701-1064
Mailing Address - Country:US
Mailing Address - Phone:217-544-2020
Mailing Address - Fax:217-544-1519
Practice Address - Street 1:301 N 8TH ST STE 6B201
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62701-1064
Practice Address - Country:US
Practice Address - Phone:217-544-2020
Practice Address - Fax:217-544-1519
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-30
Last Update Date:2008-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL08432151OtherBC/BS
IL611236600OtherACS
ILDE7074OtherRR MEDICARE GROUP#
ILDE7074OtherRR MEDICARE GROUP#