Provider Demographics
NPI:1811224710
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:PR
Authorized Official - Prefix:
Authorized Official - First Name:MISTY
Authorized Official - Middle Name:L
Authorized Official - Last Name:PELAEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
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:618-277-4917
Practice Address - Street 1:415 W MAIN ST
Practice Address - Street 2:
Practice Address - City:COLLINSVILLE
Practice Address - State:IL
Practice Address - Zip Code:62234-3043
Practice Address - Country:US
Practice Address - Phone:618-345-7887
Practice Address - Fax:618-277-4917
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-13
Last Update Date:2013-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046006474152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL4669520010Medicare NSC
IL203195Medicare PIN