Provider Demographics
NPI:1023056090
Name:GAILEY EYE SURGERY-DECATUR LLC
Entity type:Organization
Organization Name:GAILEY EYE SURGERY-DECATUR LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ARA
Authorized Official - Middle Name:D
Authorized Official - Last Name:APRAHAMIAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:309-829-5311
Mailing Address - Street 1:646 W PERSHING RD
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:IL
Mailing Address - Zip Code:62526-1633
Mailing Address - Country:US
Mailing Address - Phone:217-875-2600
Mailing Address - Fax:217-875-2700
Practice Address - Street 1:646 W PERSHING RD
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:IL
Practice Address - Zip Code:62526-1633
Practice Address - Country:US
Practice Address - Phone:217-875-2600
Practice Address - Fax:217-875-9525
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-03
Last Update Date:2025-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL50636OtherBLUE CROSS BLUE SHEILD
IL50636OtherBLUE CROSS BLUE SHEILD
IL=========001Medicaid