Provider Demographics
NPI:1487849162
Name:HEARTLAND EYECARE GROUP
Entity Type:Organization
Organization Name:HEARTLAND EYECARE GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LANCE
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:ROCKE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:309-661-9191
Mailing Address - Street 1:2501 E COLLEGE AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:61704-2484
Mailing Address - Country:US
Mailing Address - Phone:309-661-9191
Mailing Address - Fax:309-661-2259
Practice Address - Street 1:2501 E COLLEGE AVE
Practice Address - Street 2:SUITE B
Practice Address - City:BLOOMINGTON
Practice Address - State:IL
Practice Address - Zip Code:61704-2484
Practice Address - Country:US
Practice Address - Phone:309-661-9191
Practice Address - Fax:309-661-2259
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-06
Last Update Date:2007-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL46-8260152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
T91181Medicare UPIN