Provider Demographics
NPI:1679593123
Name:WYMAN SICHER EYE ASSOCIATES SC
Entity type:Organization
Organization Name:WYMAN SICHER EYE ASSOCIATES SC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:P
Authorized Official - Last Name:RHODE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:309-243-3869
Mailing Address - Street 1:8921 N. WOOD SAGE RD
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61615
Mailing Address - Country:US
Mailing Address - Phone:309-243-2400
Mailing Address - Fax:309-243-7918
Practice Address - Street 1:8921 N. WOOD SAGE RD
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61615
Practice Address - Country:US
Practice Address - Phone:309-243-2400
Practice Address - Fax:309-243-7918
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-20
Last Update Date:2019-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL07220057OtherBLUE CROSS
CL0035Medicare ID - Type UnspecifiedRAILROAD MEDICARE
IL0425500001Medicare NSC
IL07220057OtherBLUE CROSS