IRENE FEDOROVICH (NPI# 1740384189) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1740384189 |
| Entity Type | Individual |
| Full Name | IRENE FEDOROVICH |
| Credential | MD |
| Practice Address |
2401 W Main St Marion IL 62959-1188 |
| Mailing Address |
619 Lake Harbor Dr Marion IL 62959-5550 |
| Practice Telephone | 6189975311 |
| Enumeration Date | 2006-09-07 |
| Last Update Date | 2007-07-08 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207W00000X | Ophthalmology | 2003028760 | MO | Allopathic & Osteopathic Physicians |
| Y | 207W00000X | Ophthalmology | IL | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MO | LICENSE | 2003028760 | 01 |
| Street Address |
2401 W MAIN ST |
| City | MARION |
| State | IL |
| Zip Code | 62959-1188 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1841277696 | Keith D Stewart | Dentist | 2401 W Main St, Marion, IL 62959-1188 | 2005-12-22 |
| 1396353397 | John Gilmore | Nurse Practitioner | 2401 W Main St, Marion, IL 62959-1188 | 2020-07-16 |
| 1083230098 | Samantha Ann Kimble | Social Worker | 2401 W Main St, Marion, IL 62959-1188 | 2020-06-25 |
| 1659907954 | Jason Patton | Technician | 2401 W Main St, Marion, IL 62959-1188 | 2020-03-18 |
| 1275164543 | Edward Staba | Psychologist | 2401 W Main St, Marion, IL 62959-1188 | 2020-01-27 |
| 1497385918 | Megan Berkel | Technician | 2401 W Main St, Marion, IL 62959-1188 | 2020-01-23 |
| 1699316521 | Angela Trowbridge | Technician | 2401 W Main St, Marion, IL 62959-1188 | 2019-10-02 |
| 1891346276 | Donna Householder | Technician | 2401 W Main St, Marion, IL 62959-1188 | 2019-09-26 |
| 1457902918 | Brenda Frazier | Technician | 2401 W Main St, Marion, IL 62959-1188 | 2019-09-26 |
| 1043861420 | Michelle Collier | Technician | 2401 W Main St, Marion, IL 62959-1188 | 2019-09-26 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1710513486 | Sarah Benitone | Counselor | 11264 Il-37, Marion, IL 62959 | 2020-03-13 |
| 1528609328 | Patricia E Murphy | Radiology | 4503 1/2 W Deyoung, Suite 3a, Marion, IL 62959 | 2019-10-02 |
| 1366007007 | Centerstone of Illinois, Inc | Community/Behavioral Health | 202 S Bentley St, Marion, IL 62959 | 2019-05-08 |
| 1649752064 | Sydney Seiter | Occupational Therapist | 906 Skyline Suite 100, Marion, IL 62959 | 2018-09-01 |
| 1497279848 | Brooke Alisa Osman | Licensed Practical Nurse | 11531 Sunderland Road, Marion, IL 62959 | 2017-07-27 |
| 1912436429 | Joy L. Kee | Social Worker | 509 South Bentley Street, Marion, IL 62959 | 2017-06-08 |
| 1386181170 | Susan Smothers | Counselor | 1305 West Main Street, Marion, IL 62959 | 2017-01-31 |
| 1205280922 | Harish Kempegowda | Orthopaedic Surgery | 3331 W Deyoung St Ste 201, Marion, IL 62959 | 2016-04-19 |
| 1942609227 | Casey Hill | Social Worker | 1604 W. Walnut St., Marion, IL 62959 | 2014-08-22 |
| 1306252812 | Justin M White | Chiropractor | 1603 W Kimmel, Marion, IL 62959 | 2014-07-03 |
| Find all providers in zip 62959 | ||||
| Taxonomy Code | 207W00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Ophthalmology |
| An ophthalmologist has the knowledge and professional skills needed to provide comprehensive eye and vision care. Ophthalmologists are medically trained to diagnose, monitor and medically or surgically treat all ocular and visual disorders. This includes problems affecting the eye and its component structures, the eyelids, the orbit and the visual pathways. In so doing, an ophthalmologist prescribes vision services, including glasses and contact lenses. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definiton added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Ophthalmology, 2007. http://www.abop.org/. American Osteopathic Board of Ophthalmology and Otolaryngology, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Ophthalmology. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Ophthalmology and Otolaryngology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1417119488 | Michael Alan Morris | Ophthalmology | 8341 Express Dr Ste C, Marion, IL 62959-6476 | 2008-06-30 |
| 1205952249 | Omar Rizwan Ahmad | Ophthalmology | 1200 W Deyoung, Marion, IL 62959 | 2007-03-21 |
| 1528020401 | Eye Specialist of Southern Illinois, LLC | Ophthalmology | 1000 W Deyoung St, Marion, IL 62959-1630 | 2006-04-05 |
| 1295701118 | Deanna Jende Stevens | Ophthalmology | 1462 Marion Waldo Rd, Marion, OH 43302-7422 | 2006-02-28 |
| 1336137751 | Stokes Regional Eye Center | Ophthalmology | 3032 E Highway 76, Marion, SC 29571 | 2005-10-10 |
| 1770978645 | Nicholas Moore | Ophthalmology | 1462 Marion Waldo Rd, Marion, OH 43302 | 2015-03-30 |
| 1700823010 | John Charles Garvin | Ophthalmology | 1040 Delaware Avenue, Marion, OH 43301-1814 | 2006-06-02 |
| 1053369207 | Gary D Burton | Ophthalmology | 1040 Delaware Avenue, Marion, OH 43301-1814 | 2006-05-04 |
| 1104889716 | Midwest Eye Consultants, P.C. | Ophthalmology | 1800 N Wabash Rd, Suite 100, Marion, IN 46952-1300 | 2006-04-07 |
| 1518933571 | Steven Michael Kirkham | Ophthalmology | 1462 Marion Waldo Rd, Marion, OH 43302-7422 | 2006-02-28 |
| Find all providers in MARION | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.