NPIMap

Organization Active NPI

Family Eye Care of Pontiac, LLC

  • Optometrist
  • Pontiac, IL
National Provider Identifier
1003816000
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
Legal business name
FAMILY EYE CARE OF PONTIAC, LLC
Practice address
320 N Ladd St
Pontiac, IL 61764-1612
Phone
(815) 842-4304
Fax
(815) 844-5495
NPI assigned
Aug 1, 2005
Last updated
Jul 21, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Reid Allen Pettit, ODNPI 1326047531
Title
Owner
Phone
(815) 842-4304

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X IL Primary

Addresses

Primary practice location

320 N Ladd St
Pontiac, IL 61764-1612

Mailing address

320 N Ladd St
Pontiac, IL 61764-1612
Phone (815) 842-4304

Other identifiers 3

IdentifierTypeStateIssuer
4991920001OtherDME
DB0240OtherRAILROAD
05332011OtherBLUE CROSS

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1122854400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1003816000",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "320 N LADD ST",
            "city": "PONTIAC",
            "state": "IL",
            "postal_code": "617641612",
            "telephone_number": "815-842-4304",
            "fax_number": "815-844-5495"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "320 N LADD ST",
            "city": "PONTIAC",
            "state": "IL",
            "postal_code": "617641612",
            "telephone_number": "815-842-4304",
            "fax_number": "815-844-5495"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAMILY EYE CARE OF PONTIAC, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-08-01",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "PETTIT",
        "authorized_official_first_name": "REID",
        "authorized_official_middle_name": "ALLEN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "815-842-4304",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DME",
            "identifier": "4991920001",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD",
            "identifier": "DB0240",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "05332011",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Pontiac, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.