Organization
CENTER FOR SIGHT CENTRAL IL I SC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. PHILLIP D ALWARD M.D. (OWNER)
(217) 877-5050
Entity
Organization
Contact information
Practice address
304 W HAY ST, SUITE 311, DECATUR, IL 62526-6328
(217) 877-5050
(217) 877-9711
Mailing address
304 W HAY ST, SUITE 311, DECATUR, IL 62526-6328
(217) 877-5050
(217) 877-9711
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
046008823
IL
207W00000X
Ophthalmology Physician
036054803
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036054803
—
IL
05
—
046008823
—
IL
01
—
05815176
BLUE CROSS
IL
01
—
180022789
RR MEDICARE
IL
Enumeration date
02/19/2007
Last updated
09/23/2009
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