Provider Demographics
NPI:1952301129
Name:ABBA EYE CARE PC
Entity Type:Organization
Organization Name:ABBA EYE CARE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STACY
Authorized Official - Middle Name:
Authorized Official - Last Name:HIEB
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:618-462-9818
Mailing Address - Street 1:111 E 4TH ST STE 440
Mailing Address - Street 2:
Mailing Address - City:ALTON
Mailing Address - State:IL
Mailing Address - Zip Code:62002-6206
Mailing Address - Country:US
Mailing Address - Phone:618-462-9818
Mailing Address - Fax:314-741-4947
Practice Address - Street 1:1130 LAKE PLAZA DR STE 130
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80906-3595
Practice Address - Country:US
Practice Address - Phone:719-219-3819
Practice Address - Fax:314-741-4947
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-28
Last Update Date:2023-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COOPT 1000152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO04015491Medicaid
CO0727840002Medicare NSC
COCF1203Medicare ID - Type Unspecified
CO0727840001Medicare NSC
CO0727840005Medicare NSC
CO0727840003Medicare NSC
CO0727840008Medicare NSC
CO0727840006Medicare NSC
CO04015491Medicaid
CO0727840010Medicare NSC
CO0727840004Medicare NSC
CO0727840011Medicare NSC