Organization
ILLINOIS EXPRESS VISION CENTER-MATTOON INC.
Active
Other names
ILLINOIS EXPRESS EYECARE
Organization subpart
No
Provider details
NPI number
Authorized official
DR. STEVEN H LANE OD (OPTOMETRIST)
(217) 235-1100
Entity
Organization
Contact information
Practice address
420 BROADWAY AVE E, MATTOON, IL 61938-4604
(217) 235-1100
Mailing address
420 BROADWAY AVE E, MATTOON, IL 61938-4604
(217) 235-1100
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
—
—
332H00000X
Eyewear Supplier
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01523250
BLUECROSS BLUE SHIELD ID#
IL
01
—
IL7319
EYEMED PROVIDER NUMBER
IL
Enumeration date
03/21/2007
Last updated
02/04/2013
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