Organization
BROADWAY VISION CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MERVI HANNELE LEYENDECKERS O.D. (DR OF OPTOMETRY)
(217) 222-6888
Entity
Organization
Contact information
Practice address
926 BROADWAY ST, QUINCY, IL 62301-2730
(217) 222-6888
(217) 222-6975
Mailing address
926 BROADWAY ST, QUINCY, IL 62301-2730
(217) 222-6888
(217) 222-6975
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
046008462
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1083711642
NPI
IL
Enumeration date
01/31/2008
Last updated
06/25/2008
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