Provider Demographics
NPI:1821029836
Name:FAMILY EYE CARE ASSOCIATION, P.C.
Entity Type:Organization
Organization Name:FAMILY EYE CARE ASSOCIATION, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:W
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:217-532-5044
Mailing Address - Street 1:675 SCHOOL ST
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:IL
Mailing Address - Zip Code:62049-1530
Mailing Address - Country:US
Mailing Address - Phone:217-532-5044
Mailing Address - Fax:217-532-2109
Practice Address - Street 1:675 SCHOOL ST
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:IL
Practice Address - Zip Code:62049-1530
Practice Address - Country:US
Practice Address - Phone:217-532-5044
Practice Address - Fax:217-532-2109
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-06
Last Update Date:2011-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046007103152W00000X
IL046008320152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL046008093Medicaid
IL046007103Medicaid
IL046008320Medicaid
IL966170Medicare ID - Type Unspecified
IL0474650001Medicare NSC
IL930150Medicare ID - Type Unspecified
IL046008320Medicaid
IL202767Medicare ID - Type Unspecified
IL046007103Medicaid