Provider Demographics
NPI:1326192626
Name:BIXBY EYE CENTER INC
Entity Type:Organization
Organization Name:BIXBY EYE CENTER INC
Other - Org Name:THE BIXBY EYE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KREY
Authorized Official - Middle Name:A
Authorized Official - Last Name:BIXBY
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:309-692-0000
Mailing Address - Street 1:6807 N KNOXVILLE AVE
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61614-2812
Mailing Address - Country:US
Mailing Address - Phone:309-692-0000
Mailing Address - Fax:309-692-8082
Practice Address - Street 1:6807 N KNOXVILLE AVE
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61614-2812
Practice Address - Country:US
Practice Address - Phone:309-692-0000
Practice Address - Fax:309-692-8082
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-23
Last Update Date:2015-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
208699Medicare PIN
IL5036980001Medicare NSC