NPIMap

Organization Active NPI

Center for Sight of Central Illinois SC

  • Ophthalmology Physician
  • Decatur, IL
National Provider Identifier
1093854820
Registry record updated Apr 24, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ophthalmology PhysicianTaxonomy code 207W00000X
License
036069820 Issued in IL
Legal business name
CENTER FOR SIGHT OF CENTRAL ILLINOIS SC
Practice address
2442 N Route 121
Decatur, IL 62526-9461
Phone
(217) 233-3101
Fax
(217) 233-3107
NPI assigned
Feb 6, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 24, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Marcus S Deranian, MD
Title
Owner
Phone
(217) 233-3101

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193200000X MULTI-SPECIALTY GROUP 152W00000X 046009767 IL
Corneal and Contact Management OptometristGroup: 193200000X MULTI-SPECIALTY GROUP 152WC0802X 036069820 IL
Ophthalmology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207W00000X 036069820 IL Primary
Durable Medical Equipment & Medical Supplies 332B00000X 036069820 IL

Addresses

Primary practice location

2442 N Route 121
Decatur, IL 62526-9461

Mailing address

2442 N Route 121
Decatur, IL 62526-9461
Phone (217) 233-3101

Other identifiers 3

IdentifierTypeStateIssuer
036069820MedicaidIL
180033361OtherILRAILROAD MEDICARE
05822331OtherILBLUE CROSS

Other names 1

  • Central Illinois Vision Center Doing business as

National Provider Directory

National Provider Directory

Locations

308 E Broadway Ave
Centralia, IL 62801
Phone (618) 532-2537

1700 18th St
Charleston, IL 61920
Phone (217) 345-6600

4837 E Route 36
Decatur, IL 62521
Phone (217) 864-1362

1401 W Main St
Shelbyville, IL 62565
Phone (217) 774-2181

2202 W Randolph St
Vandalia, IL 62471
Phone (618) 283-3511

Practitioners & affiliated clinicians

Practitioners 15

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 15

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1170720000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1208995200000",
    "number": "1093854820",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2442 N ROUTE 121",
            "city": "DECATUR",
            "state": "IL",
            "postal_code": "625269461",
            "telephone_number": "217-233-3101",
            "fax_number": "217-233-3107"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2442 N ROUTE 121",
            "city": "DECATUR",
            "state": "IL",
            "postal_code": "625269461",
            "telephone_number": "217-233-3101",
            "fax_number": "217-233-3107"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CENTER FOR SIGHT OF CENTRAL ILLINOIS SC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-06",
        "last_updated": "2008-04-24",
        "status": "A",
        "authorized_official_last_name": "DERANIAN",
        "authorized_official_first_name": "MARCUS",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "217-233-3101",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Optometrist",
            "state": "IL",
            "license": "046009767",
            "primary": false
        },
        {
            "code": "152WC0802X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Optometrist, Corneal and Contact Management",
            "state": "IL",
            "license": "036069820",
            "primary": false
        },
        {
            "code": "207W00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Ophthalmology",
            "state": "IL",
            "license": "036069820",
            "primary": true
        },
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "IL",
            "license": "036069820",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036069820",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "180033361",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "05822331",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Central Illinois Vision Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Decatur, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 24, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.