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Contact Information

ILLINI OPTOMETRIC PC
3300 GODFREY RD
GODFREY, IL62035
 Phone: 618-466-8787
 Fax: 618-466-4703
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Optometrist

152W00000X 41 Optometry
Indicates primary specialty

NPI Profile & details for ILLINI OPTOMETRIC PC

NPI Number 1780850032
LBN Legal business name ILLINI OPTOMETRIC PC
Authorized official MARK FERGUSON - (PRESIDENT)
Entity Organization
Organization subpart 1 No
Enumeration date 05/07/2008
Last updated 05/07/2008 - About 18 years ago
Identifiers
IL License # 060005314
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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