Provider Demographics
NPI:1174667448
Name:CENTER FOR SIGHT CENTRAL IL I SC
Entity type:Organization
Organization Name:CENTER FOR SIGHT CENTRAL IL I SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PHILLIP
Authorized Official - Middle Name:D
Authorized Official - Last Name:ALWARD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:217-877-5050
Mailing Address - Street 1:304 W HAY ST
Mailing Address - Street 2:SUITE 311
Mailing Address - City:DECATUR
Mailing Address - State:IL
Mailing Address - Zip Code:62526-6328
Mailing Address - Country:US
Mailing Address - Phone:217-877-5050
Mailing Address - Fax:217-877-9711
Practice Address - Street 1:304 W HAY ST
Practice Address - Street 2:SUITE 311
Practice Address - City:DECATUR
Practice Address - State:IL
Practice Address - Zip Code:62526-6328
Practice Address - Country:US
Practice Address - Phone:217-877-5050
Practice Address - Fax:217-877-9711
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-19
Last Update Date:2009-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036054803207W00000X
IL046008823152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036054803Medicaid
IL046008823Medicaid
IL05815176OtherBLUE CROSS
IL180022789OtherRR MEDICARE
IL036054803Medicaid
IL352451Medicare Oscar/Certification
ILL33535Medicare PIN
IL180022789OtherRR MEDICARE
ILC45427Medicare UPIN
IL05815176OtherBLUE CROSS
ILL33534Medicare PIN
IL046008823Medicaid