Provider Demographics
NPI:1194880005
Name:MARION EYE CENTERS, LTD.
Entity type:Organization
Organization Name:MARION EYE CENTERS, LTD.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MAQBOOL
Authorized Official - Middle Name:
Authorized Official - Last Name:AHMAD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:618-993-5686
Mailing Address - Street 1:1200 W DEYOUNG ST
Mailing Address - Street 2:P.O. BOX 1178
Mailing Address - City:MARION
Mailing Address - State:IL
Mailing Address - Zip Code:62959-4437
Mailing Address - Country:US
Mailing Address - Phone:618-993-5686
Mailing Address - Fax:618-997-5505
Practice Address - Street 1:297 SILVER SPRINGS RD.
Practice Address - Street 2:
Practice Address - City:CAPE GIRARDEAU
Practice Address - State:MO
Practice Address - Zip Code:63701
Practice Address - Country:US
Practice Address - Phone:573-651-5200
Practice Address - Fax:573-651-3743
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-22
Last Update Date:2017-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036051996332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO203169800Medicaid
IL036051996Medicaid
C51321Medicare UPIN
MO203169800Medicaid
ILP12420Medicare ID - Type Unspecified
IL036051996Medicaid
MO0814870013Medicare NSC