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100 E Main St, Mascoutah, IL 62258-2135 | |
(618) 566-8899 | |
Not Available |
Full Name | |
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Type | Facility |
Speciality | Optometrist |
Location | 100 E Main St, Mascoutah, Illinois |
Accepts Medicare Assignments | Medicare enrolled and accepts medicare insurance. Providers at this facility may prescribe medicare part D drugs. |
Identifier | Type | State | Issuer |
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1851608186 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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152W00000X | Optometrist | 046008579 (Illinois) | Secondary |
152W00000X | Optometrist | 046006501 (Illinois) | Primary |
Provider Name | Marianne W Mcdaniel |
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Provider Type | Practitioner - Optometry |
Provider Identifiers | NPI Number: 1588793731 PECOS PAC ID: 0547441727 Enrollment ID: I20110221000992 |
Provider Name | David Junge |
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Provider Type | Practitioner - Optometry |
Provider Identifiers | NPI Number: 1942938626 PECOS PAC ID: 2961886478 Enrollment ID: I20220901001797 |
Mailing Address | Practice Location Address |
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100 E Main St, Mascoutah, IL 62258-2135 Ph: (618) 566-8899 | 100 E Main St, Mascoutah, IL 62258-2135 Ph: (618) 566-8899 |