Provider Demographics
NPI:1710180922
Name:DR ERIC BOTTS & ASSOCIATES LLC
Entity Type:Organization
Organization Name:DR ERIC BOTTS & ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:
Authorized Official - Last Name:BOTTS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:309-333-6344
Mailing Address - Street 1:PO BOX 465
Mailing Address - Street 2:1730 E JACKSON ST
Mailing Address - City:MACOMB
Mailing Address - State:IL
Mailing Address - Zip Code:61455-0465
Mailing Address - Country:US
Mailing Address - Phone:309-333-6344
Mailing Address - Fax:
Practice Address - Street 1:1730 E JACKSON ST
Practice Address - Street 2:
Practice Address - City:MACOMB
Practice Address - State:IL
Practice Address - Zip Code:61455-2531
Practice Address - Country:US
Practice Address - Phone:309-836-3373
Practice Address - Fax:309-836-3375
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-06
Last Update Date:2017-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL988910Medicare PIN