| |
420 Broadway Ave E, Mattoon, IL 61938-4604 | |
(217) 235-1100 | |
Not Available |
Full Name | |
---|---|
Type | Facility |
Speciality | Eyewear Supplier |
Location | 420 Broadway Ave E, Mattoon, Illinois |
Accepts Medicare Assignments | Does not participate in Medicare Program. The facility may not accept medicare assignment. |
Identifier | Type | State | Issuer |
---|---|---|---|
1760508931 | NPI | - | NPPES |
IL7319 | Other | IL | EYEMED PROVIDER NUMBER |
01523250 | Other | IL | BLUECROSS BLUE SHIELD ID# |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
152W00000X | Optometrist | (* (Not Available)) | Secondary |
332H00000X | Eyewear Supplier | (* (Not Available)) | Primary |
Mailing Address | Practice Location Address |
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420 Broadway Ave E, Mattoon, IL 61938-4604 Ph: (217) 235-1100 | 420 Broadway Ave E, Mattoon, IL 61938-4604 Ph: (217) 235-1100 |