# CENTER FOR SIGHT OF CENTRAL ILLINOIS SC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Central Illinois Vision Center
- **Organization subpart:** No

## Provider details

- **NPI number:** 1093854820
- **Authorized official:** DR. MARCUS S DERANIAN MD (OWNER)
- **Authorized official phone:** (217) 233-3101

## Contact information

- **Practice address:** 2442 N ROUTE 121, DECATUR, IL 62526-9461
- **Practice address phone:** (217) 233-3101
- **Practice address fax:** (217) 233-3107
- **Mailing address:** 2442 N ROUTE 121, DECATUR, IL 62526-9461
- **Mailing address phone:** (217) 233-3101
- **Mailing address fax:** (217) 233-3107

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 152W00000X | Optometrist | 046009767 | IL | — |
| 152WC0802X | Corneal and Contact Management Optometrist | 036069820 | IL | — |
| 207W00000X | Ophthalmology Physician | 036069820 | IL | Yes |
| 332B00000X | Durable Medical Equipment & Medical Supplies | 036069820 | IL | — |

## Other

- **Enumeration date:** 02/06/2007
- **Last updated:** 04/24/2008

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 036069820 | — | IL |
| 01 | — | 05822331 | BLUE CROSS | IL |
| 01 | — | 180033361 | RAILROAD MEDICARE | IL |