Individual
KEITH TYHURST
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
1200 W DEYOUNG ST, MARION, IL 62959-4437
(618) 993-5686
(618) 997-6250
Mailing address
1200 W DEYOUNG ST, MARION, IL 62959-4437
(618) 993-5686
(618) 997-6250
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
046-009941
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
046009941
—
IL
01
—
0814870001
MEDICARE NSC NUMBER
IL
01
—
0814870007
MEDICARE NSC NUMBER
IL
01
—
0814870008
MEDICARE NSC NUMBER
IL
01
—
0814870022
MEDICARE NSC NUMBER
IL
01
—
0814870025
MEDICARE NSC NUMBER
IL
01
—
0814870031
MEDICARE NSC NUMBER
IL
01
—
134731
HEALTH ALLIANCE
—
01
—
IL9941
EYEMED
—
01
—
P00418695
MEDICARE RAILROAD
IL
Enumeration date
06/08/2007
Last updated
10/06/2008
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