# PRAIRIE EYE CENTER, LTD

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** PRAIRIE EYE CENTER, LTD
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1679166953
- **Legal business name:** PRAIRIE EYE CENTER, LTD
- **Authorized official:** JASON LANG (BILLING ADMINISTRATOR)
- **Authorized official phone:** (217) 698-3030

## Contact information

- **Practice address:** 960 E MOUND RD, DECATUR, IL 62526-2099
- **Practice address phone:** (217) 877-5050
- **Practice address fax:** (217) 877-9711
- **Mailing address:** 2020 W ILES AVE, SPRINGFIELD, IL 62704-4174
- **Mailing address phone:** (217) 698-3030
- **Mailing address fax:** (217) 698-3068

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 152W00000X | Optometrist | — | NULL | — |
| 152W00000X | Optometrist | — | — | — |
| 207W00000X | Ophthalmology Physician | — | NULL | Yes |
| 207W00000X | Ophthalmology Physician | — | — | Yes |

## Other

- **Enumeration date:** 02/17/2021
- **Last updated:** 02/17/2021