Provider Demographics
NPI:1699806919
Name:EYECARE MANAGEMENT LLC
Entity Type:Organization
Organization Name:EYECARE MANAGEMENT LLC
Other - Org Name:QUANTUM VISION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BILLING DEPARTMENT MGR
Authorized Official - Prefix:
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:L
Authorized Official - Last Name:CUMMINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:618-277-1130
Mailing Address - Street 1:111 W LINCOLN ST
Mailing Address - Street 2:
Mailing Address - City:BELLEVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62220-2019
Mailing Address - Country:US
Mailing Address - Phone:618-277-1130
Mailing Address - Fax:618-937-8403
Practice Address - Street 1:12818 TESSON FERRY RD
Practice Address - Street 2:SUITE 201
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63128-2945
Practice Address - Country:US
Practice Address - Phone:314-843-4044
Practice Address - Fax:314-843-2941
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-08
Last Update Date:2015-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO202559308Medicaid
MO317834034Medicaid
MO202559308Medicaid
MO317834034Medicaid
MOU60607Medicare UPIN
MO4669520019Medicare NSC