Provider Demographics
NPI:1932207073
Name:EYECARE OF ILLINOIS LTD
Entity Type:Organization
Organization Name:EYECARE OF ILLINOIS LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:A
Authorized Official - Last Name:SIERON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:618-257-9800
Mailing Address - Street 1:5308 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BELLEVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62226-4733
Mailing Address - Country:US
Mailing Address - Phone:618-257-9800
Mailing Address - Fax:618-355-7800
Practice Address - Street 1:5308 WEST MAIN ST
Practice Address - Street 2:
Practice Address - City:BELLEVILLE
Practice Address - State:IL
Practice Address - Zip Code:62226
Practice Address - Country:US
Practice Address - Phone:618-257-9800
Practice Address - Fax:618-355-7800
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2013-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046007892152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL556550Medicare PIN
L72995Medicare UPIN
IL0388550001Medicare NSC
IL556830Medicare PIN
L72961Medicare UPIN
ILCL2056Medicare PIN