Provider Demographics
NPI:1851445621
Name:MARION EYE CENTERS LTD.
Entity Type:Organization
Organization Name:MARION EYE CENTERS LTD.
Other - Org Name:MARION EYE CENTERS, LTD.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MAQBOOL
Authorized Official - Middle Name:
Authorized Official - Last Name:AHMAD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:618-993-5686
Mailing Address - Street 1:1200 W DEYOUNG ST
Mailing Address - Street 2:P.O. BOX 1178
Mailing Address - City:MARION
Mailing Address - State:IL
Mailing Address - Zip Code:62959-4437
Mailing Address - Country:US
Mailing Address - Phone:618-993-5686
Mailing Address - Fax:618-997-5505
Practice Address - Street 1:821 S WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:DU QUOIN
Practice Address - State:IL
Practice Address - Zip Code:62832-1909
Practice Address - Country:US
Practice Address - Phone:800-344-7058
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-22
Last Update Date:2017-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036051996332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036051996Medicaid
MO203169800Medicaid
ILP12420Medicare ID - Type Unspecified
IL036051996Medicaid
MO203169800Medicaid
IL0814870027Medicare NSC
MO000004665Medicare ID - Type Unspecified