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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