Organization Name: | BROADWAY VISION CENTER |
NPI Number: | 1629256730 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | MERVI HANNELE LEYENDECKERS (DR OF OPTOMETRY) |
Mailing Address: | 926 Broadway St Quincy |
State: | IL US |
Postal Code: | 623012730 |
Phone Number: | 2172226888 |
Fax Number: | 2172226975 |
NPI Enumeration Date: | 01/31/2008 |
NPI Last Update Date: | 06/25/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 332B00000X |
License Number: | 046008462 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IL |
Taxonomy Type: | Suppliers |
Taxonomy Classification: | Durable Medical Equipment & Medical Supplies |
Taxonomy Specialization: | |
Taxonomy Definition: | A supplier of medical equipment such as respirators, wheelchairs, home dialysis systems, or monitoring systems, that are prescribed by a physician for a patient |