Organization
SALEM EYE CLINIC LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ALAN D MONTGOMERY OD (OWNER)
(618) 548-3506
Entity
Organization
Contact information
Practice address
400 NORTH BROADWAY, SALEM, IL 62881
(618) 548-3506
(618) 548-2555
Mailing address
400 NORTH BROADWAY, SALEM, IL 62881
(618) 548-3506
(618) 548-2555
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
06132027
BLUE CROSS BLUE SHIELD
IL
Enumeration date
01/22/2007
Last updated
03/28/2008
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