Provider Demographics
NPI:1558555466
Name:EYECARE MANAGEMENT, LLC
Entity Type:Organization
Organization Name:EYECARE MANAGEMENT, LLC
Other - Org Name:ILLINOIS EYE SURGEONS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BART
Authorized Official - Middle Name:AARON
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:618-532-1082
Mailing Address - Street 1:3990 N ILLINOIS ST
Mailing Address - Street 2:
Mailing Address - City:SWANSEA
Mailing Address - State:IL
Mailing Address - Zip Code:62226-1919
Mailing Address - Country:US
Mailing Address - Phone:618-277-1130
Mailing Address - Fax:618-277-1130
Practice Address - Street 1:111 W LINCOLN ST
Practice Address - Street 2:
Practice Address - City:BELLEVILLE
Practice Address - State:IL
Practice Address - Zip Code:62220-2019
Practice Address - Country:US
Practice Address - Phone:618-234-1774
Practice Address - Fax:618-234-7979
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-04
Last Update Date:2013-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036104178152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036104178Medicaid
IL036104178Medicaid