Organization
ILLINOIS EXPRESS VISION CENTER, MATTOON INC
Active
Other names
MT VERNON EYECARE
Organization subpart
No
Provider details
NPI number
Authorized official
AMY MARIE MILLER (ASSISTANT MANAGER)
(217) 235-1100
Entity
Organization
Contact information
Practice address
3917 BROADWAY ST, TIMES SQUARE MALL, MOUNT VERNON, IL 62864-2290
(618) 244-5522
(618) 244-9512
Mailing address
420 BROADWAY AVE E, MATTOON, IL 61938-4604
(217) 235-1100
(217) 235-1126
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
371279746001
—
IL
Enumeration date
02/28/2008
Last updated
03/23/2016
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