Provider Demographics
NPI:1932116449
Name:SARMIENTO, MARC CHRISTOPHER (OD)
Entity Type:Individual
Prefix:DR
First Name:MARC
Middle Name:CHRISTOPHER
Last Name:SARMIENTO
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
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Other - Middle Name:
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Mailing Address - Street 1:8309 N KNOXVILLE AVE
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61615-2170
Mailing Address - Country:US
Mailing Address - Phone:309-693-9540
Mailing Address - Fax:309-693-9754
Practice Address - Street 1:3055 WABASH AVE
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62704-6414
Practice Address - Country:US
Practice Address - Phone:217-793-2273
Practice Address - Fax:217-793-2278
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2015-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046-008789152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILU62137Medicare UPIN