Marengo Vision Center, P.C.
Organization Active NPI Optometrist · Marengo, IL
NPI 1992736276 · NPPES record last updated Aug 23, 2010
Key facts
- NPI
- 1992736276
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Optometrist 152W00000X
- License
- 060009322 (IL)
- Legal business name
- MARENGO VISION CENTER, P.C.
- Practice address
- 205 N State St
Marengo, IL 60152-2239 - Phone
- (815) 568-6508
- NPI assigned
- Jul 5, 2006
- Organization subpart
- No
Authorized official
- Name
- Dr. Michael W. Thomas
- Title
- President
- Phone
- (815) 568-6508
Other NPIs on the same Medicare enrollment 1
Practitioners 4
-
Jeffrey T Caron, P.C.
-
Jon W Russell, O.D.
-
Michael William Thomas, O.D.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IL
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20060724000159 | IL | Part B Supplier - Clinic/Group Practice | 8426061169 |
Receives reassigned benefits from 4 practitioners 1 other NPI on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Harvard, IL; Johnsburg, IL; Marengo, IL |
National Provider Directory
Locations
3920 N Wilmot Rd
Johnsburg, IL 60051
Phone (815) 344-0088
205 N State St
Marengo, IL 60152
Phone (815) 568-6508
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist |
152W00000X | 060009322 | IL | Yes |
Addresses
Primary practice location
205 N State St
Marengo, IL 60152-2239
Mailing address
205 N State St
Marengo, IL 60152-2239
Other providers in Marengo, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 23, 2010. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.