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Organization
CENTER FOR SIGHT OF CENTRAL ILLINOIS SC
Active
Organization
CENTER FOR SIGHT OF CENTRAL ILLINOIS SC
Active
Other names
Central Illinois Vision Center
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MARCUS S DERANIAN MD (OWNER)
(217) 233-3101
Entity
Organization
Contact information
Practice address
2442 N ROUTE 121, DECATUR, IL 62526-9461
(217) 233-3101
(217) 233-3107
Mailing address
2442 N ROUTE 121, DECATUR, IL 62526-9461
(217) 233-3101
(217) 233-3107
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
046009767
IL
152WC0802X
Corneal and Contact Management Optometrist
036069820
IL
207W00000X
Ophthalmology Physician
Primary
036069820
IL
332B00000X
Durable Medical Equipment & Medical Supplies
036069820
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036069820
—
IL
01
—
05822331
BLUE CROSS
IL
01
—
180033361
RAILROAD MEDICARE
IL
Enumeration date
02/06/2007
Last updated
04/24/2008
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