Organization
EYE SPECIALIST OF SOUTHERN ILLINOIS, LLC
Active
Other names
Kies Eye Center
Organization subpart
No
Provider details
NPI number
Authorized official
DAVID C ANDERSON (PRACTICE ADMINISTRATOR)
(573) 335-9175
Entity
Organization
Contact information
Practice address
1000 W DEYOUNG ST, MARION, IL 62959-1630
(618) 993-0068
(618) 993-0968
Mailing address
1429 N MOUNT AUBURN RD, CAPE GIRARDEAU, MO 63701-2171
(573) 335-9175
(573) 334-3390
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10032015
BLUECROSS BLUESHIELD
IL
01
—
CK8965
RAILROAD MEDICARE
IL
Enumeration date
04/05/2006
Last updated
10/03/2007
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