Provider Demographics
NPI:1942862214
Name:HAVERA EYE CARE SPECIALISTS LLC
Entity Type:Organization
Organization Name:HAVERA EYE CARE SPECIALISTS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:A
Authorized Official - Last Name:HAVERA
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:618-344-0511
Mailing Address - Street 1:2701 FIELDSTONE DR
Mailing Address - Street 2:
Mailing Address - City:MARYVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62062-6436
Mailing Address - Country:US
Mailing Address - Phone:217-259-9023
Mailing Address - Fax:
Practice Address - Street 1:119 N MORRISON AVE
Practice Address - Street 2:
Practice Address - City:COLLINSVILLE
Practice Address - State:IL
Practice Address - Zip Code:62234-3226
Practice Address - Country:US
Practice Address - Phone:618-344-0511
Practice Address - Fax:618-344-0545
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-08
Last Update Date:2019-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty