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Organization

EYE SURGERY CENTER OF MARYVILLE LLC

Active
Other names
Eyes of Illinois Surgery Center
Organization subpart
No

Provider details

NPI number
Authorized official
JOSEPH PRAVOOT GIRA MD (VP, CMO)
(314) 909-0633
Entity
Organization

Contact information

Practice address
12 PROFESSIONAL PARK DR, MARYVILLE, IL 62062-5672
(618) 288-7483
(618) 288-4583
Mailing address
12 PROFESSIONAL PARK DR, MARYVILLE, IL 62062-5672
(618) 288-7483
(618) 288-7196

Taxonomy

Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
7002132
IL

Other

Enumeration date
07/07/2005
Last updated
04/11/2024
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