Provider Demographics
NPI:1114200896
Name:SPECS CARTHAGE
Entity Type:Organization
Organization Name:SPECS CARTHAGE
Other - Org Name:SUPERIOR PERFORMANCE EYE CARE SPECIALIST
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:LEONARD
Authorized Official - Last Name:HAYDEN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:217-357-9750
Mailing Address - Street 1:195 S 36TH ST
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:IL
Mailing Address - Zip Code:62301-5801
Mailing Address - Country:US
Mailing Address - Phone:217-224-7732
Mailing Address - Fax:217-214-9437
Practice Address - Street 1:514 WABASH AVE
Practice Address - Street 2:
Practice Address - City:CARTHAGE
Practice Address - State:IL
Practice Address - Zip Code:62321-1360
Practice Address - Country:US
Practice Address - Phone:217-357-9750
Practice Address - Fax:217-214-9437
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-20
Last Update Date:2011-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046.009104152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty