Provider Demographics
NPI:1932263134
Name:MARION EYE CENTERS, LTD.
Entity Type:Organization
Organization Name:MARION EYE CENTERS, LTD.
Other - Org Name:MARION EYE CENTERS, LTD.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MAQBOOL
Authorized Official - Middle Name:
Authorized Official - Last Name:AHMAD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:618-993-5686
Mailing Address - Street 1:1200 W DEYOUNG ST
Mailing Address - Street 2:P.O. BOX 1178
Mailing Address - City:MARION
Mailing Address - State:IL
Mailing Address - Zip Code:62959-4437
Mailing Address - Country:US
Mailing Address - Phone:618-993-5686
Mailing Address - Fax:618-997-5505
Practice Address - Street 1:1207 N ONE MILE RD
Practice Address - Street 2:
Practice Address - City:DEXTER
Practice Address - State:MO
Practice Address - Zip Code:63841-1041
Practice Address - Country:US
Practice Address - Phone:573-624-4584
Practice Address - Fax:573-624-4585
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-21
Last Update Date:2017-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO35374152W00000X, 207W00000X
332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036051996Medicaid
MO203169800Medicaid
MO0814870002Medicare NSC
C51321Medicare UPIN
MO203169800Medicaid
MO000004665Medicare ID - Type Unspecified
ILP12420Medicare ID - Type Unspecified