Organization
EYE SURGICAL ASSOCIATES SC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. EDWARD L COLLOTON MD (DOCTOR)
(309) 662-7700
Entity
Organization
Contact information
Practice address
1505 EASTLAND DR, SUITE 2200, BLOOMINGTON, IL 61701-3534
(309) 662-7700
(309) 662-0829
Mailing address
1505 EASTLAND DR, SUITE 2200, BLOOMINGTON, IL 61701-3534
(309) 662-7700
(309) 662-0829
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
042006101
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
005700231
BC/BS PROV #
IL
Enumeration date
06/24/2006
Last updated
04/28/2010
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