Provider Demographics
NPI:1760653158
Name:VISION HEALTH EYECARE CENTER LTD
Entity Type:Organization
Organization Name:VISION HEALTH EYECARE CENTER LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:R
Authorized Official - Last Name:SKUTTA
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:815-786-6393
Mailing Address - Street 1:823 E CHURCH ST STE B
Mailing Address - Street 2:
Mailing Address - City:SANDWICH
Mailing Address - State:IL
Mailing Address - Zip Code:60548-1890
Mailing Address - Country:US
Mailing Address - Phone:815-786-6393
Mailing Address - Fax:815-786-6724
Practice Address - Street 1:823 E CHURCH ST STE B
Practice Address - Street 2:
Practice Address - City:SANDWICH
Practice Address - State:IL
Practice Address - Zip Code:60548-1890
Practice Address - Country:US
Practice Address - Phone:815-786-6393
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-13
Last Update Date:2018-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL212115Medicare PIN