Provider Demographics
NPI:1700885175
Name:FARRELL, JAMES WILLIAM (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:WILLIAM
Last Name:FARRELL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1008 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:61701-1784
Mailing Address - Country:US
Mailing Address - Phone:800-325-7706
Mailing Address - Fax:
Practice Address - Street 1:101 N PARKWAY DR
Practice Address - Street 2:
Practice Address - City:PEKIN
Practice Address - State:IL
Practice Address - Zip Code:61554-3932
Practice Address - Country:US
Practice Address - Phone:309-347-5115
Practice Address - Fax:309-347-7036
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-19
Last Update Date:2013-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036078398207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL9000192OtherBLUE CROSS BLUE SHIELD
IL036078398Medicaid
IL036078398Medicaid
ILB64896Medicare UPIN