Provider Demographics
NPI:1598953994
Name:METRO EYE CARE PC
Entity Type:Organization
Organization Name:METRO EYE CARE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:LEWIS
Authorized Official - Middle Name:F
Authorized Official - Last Name:JONES
Authorized Official - Suffix:III
Authorized Official - Credentials:OD
Authorized Official - Phone:618-659-1900
Mailing Address - Street 1:6620 CENTER GROVE RD
Mailing Address - Street 2:SUITE 3
Mailing Address - City:EDWARDSVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62025-2802
Mailing Address - Country:US
Mailing Address - Phone:618-659-1900
Mailing Address - Fax:618-659-1901
Practice Address - Street 1:6620 CENTER GROVE RD
Practice Address - Street 2:SUITE 3
Practice Address - City:EDWARDSVILLE
Practice Address - State:IL
Practice Address - Zip Code:62025-2802
Practice Address - Country:US
Practice Address - Phone:618-659-1900
Practice Address - Fax:618-659-1901
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-10
Last Update Date:2009-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046009304152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL5597450001Medicare NSC
ILU61183Medicare UPIN