Provider Demographics
NPI:1497928477
Name:BISHOP FAMILY EYECARE LTD
Entity Type:Organization
Organization Name:BISHOP FAMILY EYECARE LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DEAN
Authorized Official - Middle Name:E
Authorized Official - Last Name:BISHOP
Authorized Official - Suffix:JR
Authorized Official - Credentials:OD
Authorized Official - Phone:618-498-8187
Mailing Address - Street 1:201 W EXCHANGE ST
Mailing Address - Street 2:
Mailing Address - City:JERSEYVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62052-1602
Mailing Address - Country:US
Mailing Address - Phone:618-498-8187
Mailing Address - Fax:618-498-8190
Practice Address - Street 1:201 W EXCHANGE ST
Practice Address - Street 2:
Practice Address - City:JERSEYVILLE
Practice Address - State:IL
Practice Address - Zip Code:62052-1602
Practice Address - Country:US
Practice Address - Phone:618-498-8187
Practice Address - Fax:618-498-8190
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-10
Last Update Date:2009-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046008651152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILU80623Medicare UPIN
IL4326210001Medicare NSC
IL585610Medicare PIN