Provider Demographics
NPI:1922540079
Name:TAZEWELL COUNTY RESOURCE CENTERS, INC.
Entity Type:Organization
Organization Name:TAZEWELL COUNTY RESOURCE CENTERS, INC.
Other - Org Name:TCRC SIGHT CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:VP OF FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:L
Authorized Official - Last Name:SVYMBERSKY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:309-347-7148
Mailing Address - Street 1:21310 STATE ROUTE 9
Mailing Address - Street 2:
Mailing Address - City:TREMONT
Mailing Address - State:IL
Mailing Address - Zip Code:61568-9252
Mailing Address - Country:US
Mailing Address - Phone:309-347-7148
Mailing Address - Fax:
Practice Address - Street 1:21310 STATE ROUTE 9
Practice Address - Street 2:
Practice Address - City:TREMONT
Practice Address - State:IL
Practice Address - Zip Code:61568-9252
Practice Address - Country:US
Practice Address - Phone:309-347-7148
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-07
Last Update Date:2016-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152WL0500XEye and Vision Services ProvidersOptometristLow Vision RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILU71114Medicare UPIN