Provider Demographics
NPI:1932200094
Name:MACON COUNTY EYE CENTER PC
Entity Type:Organization
Organization Name:MACON COUNTY EYE CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SUSHANT
Authorized Official - Middle Name:K
Authorized Official - Last Name:SINHA
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:217-875-0300
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:217-875-0300
Mailing Address - Fax:217-875-9525
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:217-875-0300
Practice Address - Fax:217-875-9525
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-25
Last Update Date:2011-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL060006631207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL385160Medicare ID - Type UnspecifiedOPHTHALMOLOGY GROUP NUMBE
IL1105390001Medicare NSC
ILCM2217Medicare ID - Type UnspecifiedRR MEDICARE GROUP #