# EYE SURGICAL ASSOCIATES SC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1396771002
- **Authorized official:** DR. EDWARD L COLLOTON MD (DOCTOR)
- **Authorized official phone:** (309) 662-7700

## Contact information

- **Practice address:** 1505 EASTLAND DR, SUITE 2200, BLOOMINGTON, IL 61701-3534
- **Practice address phone:** (309) 662-7700
- **Practice address fax:** (309) 662-0829
- **Mailing address:** 1505 EASTLAND DR, SUITE 2200, BLOOMINGTON, IL 61701-3534
- **Mailing address phone:** (309) 662-7700
- **Mailing address fax:** (309) 662-0829

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207W00000X | Ophthalmology Physician | 042006101 | IL | Yes |

## Other

- **Enumeration date:** 06/24/2006
- **Last updated:** 04/28/2010

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 005700231 | BC/BS PROV \# | IL |