| |
991 Fairfax St, Carlyle, IL 62231-1811 | |
(618) 594-2663 | |
(618) 594-1322 |
Full Name | |
---|---|
Type | Facility |
Speciality | Optometrist |
Location | 991 Fairfax St, Carlyle, Illinois |
Accepts Medicare Assignments | Does not participate in Medicare Program. The facility may not accept medicare assignment. |
Identifier | Type | State | Issuer |
---|---|---|---|
1992999890 | NPI | - | NPPES |
036104178 | Medicaid | IL |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
152W00000X | Optometrist | 036104178 (Illinois) | Primary |
Mailing Address | Practice Location Address |
---|---|
3990 N Illinois St, Swansea, IL 62226-1919 Ph: (618) 277-1130 | 991 Fairfax St, Carlyle, IL 62231-1811 Ph: (618) 594-2663 |