Provider Demographics
NPI:1326193020
Name:MIDWEST EYE ASSOCIATES, LLC
Entity Type:Organization
Organization Name:MIDWEST EYE ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LANCE
Authorized Official - Middle Name:P
Authorized Official - Last Name:STEAHLY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:217-529-3937
Mailing Address - Street 1:1122 VETERANS DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:JACKSONVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62650-4032
Mailing Address - Country:US
Mailing Address - Phone:217-245-9581
Mailing Address - Fax:217-529-0968
Practice Address - Street 1:1122 VETERANS DR
Practice Address - Street 2:SUITE B
Practice Address - City:JACKSONVILLE
Practice Address - State:IL
Practice Address - Zip Code:62650-4032
Practice Address - Country:US
Practice Address - Phone:217-245-9581
Practice Address - Fax:217-529-0968
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-24
Last Update Date:2008-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL152W00000X, 207W00000X
332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332H00000XSuppliersEyewear Supplier
No152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL4820570001Medicare NSC