Organization
SITE VISION CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RAYMOND J GIANFRIDDO O.D. (SECRETARY)
(217) 228-2060
Entity
Organization
Contact information
Practice address
3236 BROADWAY ST, QUINCY, IL 62301-3712
(217) 228-2060
(217) 228-2066
Mailing address
3236 BROADWAY ST, QUINCY, IL 62301-3712
(217) 228-2060
(217) 228-2066
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0326000001
DME SUPPLIER ID
IL
Enumeration date
10/02/2008
Last updated
10/02/2008
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