# EYE SPECIALIST OF SOUTHERN ILLINOIS, LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Kies Eye Center
- **Organization subpart:** No

## Provider details

- **NPI number:** 1528020401
- **Authorized official:** DAVID C ANDERSON (PRACTICE ADMINISTRATOR)
- **Authorized official phone:** (573) 335-9175

## Contact information

- **Practice address:** 1000 W DEYOUNG ST, MARION, IL 62959-1630
- **Practice address phone:** (618) 993-0068
- **Practice address fax:** (618) 993-0968
- **Mailing address:** 1429 N MOUNT AUBURN RD, CAPE GIRARDEAU, MO 63701-2171
- **Mailing address phone:** (573) 335-9175
- **Mailing address fax:** (573) 334-3390

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207W00000X | Ophthalmology Physician | — | NULL | Yes |
| 207W00000X | Ophthalmology Physician | — | — | Yes |

## Other

- **Enumeration date:** 04/05/2006
- **Last updated:** 10/03/2007

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 10032015 | BLUECROSS BLUESHIELD | IL |
| 01 | — | CK8965 | RAILROAD MEDICARE | IL |