Provider Demographics
NPI:1508526864
Name:CHRISTIAN COUNTY VISIONARY ASSOCIATES
Entity Type:Organization
Organization Name:CHRISTIAN COUNTY VISIONARY ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPTOMETRIST
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:217-342-2672
Mailing Address - Street 1:904 W SPRINGFIELD RD
Mailing Address - Street 2:
Mailing Address - City:TAYLORVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62568-1213
Mailing Address - Country:US
Mailing Address - Phone:217-287-2020
Mailing Address - Fax:
Practice Address - Street 1:104 OAK ST # 5
Practice Address - Street 2:
Practice Address - City:PANA
Practice Address - State:IL
Practice Address - Zip Code:62557-1580
Practice Address - Country:US
Practice Address - Phone:217-562-2512
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-28
Last Update Date:2021-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty