Organization Active NPI

Regional Eyecare Associates Inc

  • Optometrist
  • O'Fallon, MO
National Provider Identifier
1043380652
Registry record updated Oct 20, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
T03134 Issued in MO
Legal business name
REGIONAL EYECARE ASSOCIATES INC
Practice address
3013 Winghaven Blvd
O Fallon, MO 63368-3600
Phone
(636) 561-3937
Fax
(636) 561-4068
NPI assigned
Nov 9, 2006
Last updated
Oct 20, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 20, 2025

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

Authorized official

Name
Dr. Lisa M Mackey, ODNPI 1982693297
Title
OD VP
Phone
(636) 561-3937

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193200000X MULTI-SPECIALTY GROUP 152W00000X T03134 MO Primary
OptometristGroup: 193200000X MULTI-SPECIALTY GROUP 152W00000X T03118 MO
OptometristGroup: 193200000X MULTI-SPECIALTY GROUP 152W00000X 2003015589 MO

Addresses

Primary practice location

3013 Winghaven Blvd
O Fallon, MO 63368-3600

Mailing address

3013 Winghaven Blvd
O Fallon, MO 63368-3600
Phone (636) 561-3937

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20050517000101 MO Part B Supplier - Clinic/Group Practice 2961443395 Receives reassigned benefits from 19 practitioners
Practice locations: O Fallon, MO; Wentzville, MO; Saint Charles, MO; Hillsboro, MO; Cottleville, MO; Cuba, MO
O20100930036332 MO DME Supplier - Physician - OptometristDME Supplier - Optician 2961443395 Practice locations: O Fallon, MO

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
26D2156512Regional Eyecare Associates3013 Winghaven Boulevard, O Fallon, MO 63368Certificate of waiverOct 14, 2027

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
Regional Eyecare Associates3013 Winghaven Blvd, O Fallon, MO 63368-3600(636) 561-3937 Prosthetic Lenses: Conventional Eyeglasses Accepts assignmentParticipating since Mar 15, 2005

National Provider Directory

National Provider Directory

Locations

11339 Highway 21
Hillsboro, MO 63050
Phone (636) 586-7770

3013 Winghaven Blvd
O Fallon, MO 63368
Phone (636) 561-3937

9979 Winghaven Blvd
Ste 210
O Fallon, MO 63368

3758 Elm St
Saint Charles, MO 63301
Phone (636) 757-3553

3821 Veterans Memorial Pkwy
Saint Peters, MO 63376
Phone (636) 928-1111

4702 Mid Rivers Mall Dr
Saint Peters, MO 63376
Phone (636) 244-5378

1526 W Meyer Rd
Wentzville, MO 63385
Phone (636) 239-9011

853 Medical Dr
Ste 113
Wentzville, MO 63385
Phone (636) 327-8433

Practitioners & affiliated clinicians

Practitioners 23

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.

View all 23

NPI Registry JSON

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

{
    "created_epoch": "1163030400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1760918400000",
    "number": "1043380652",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3013 WINGHAVEN BLVD",
            "city": "O FALLON",
            "state": "MO",
            "postal_code": "633683600",
            "telephone_number": "636-561-3937",
            "fax_number": "636-561-4068"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3013 WINGHAVEN BLVD",
            "city": "O FALLON",
            "state": "MO",
            "postal_code": "633683600",
            "telephone_number": "636-561-3937",
            "fax_number": "636-561-4068"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REGIONAL EYECARE ASSOCIATES INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-09",
        "last_updated": "2025-10-20",
        "certification_date": "2025-10-20",
        "status": "A",
        "authorized_official_last_name": "MACKEY",
        "authorized_official_first_name": "LISA",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "OD VP",
        "authorized_official_telephone_number": "636-561-3937",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Optometrist",
            "state": "MO",
            "license": "T03134",
            "primary": true
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Optometrist",
            "state": "MO",
            "license": "T03118",
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Optometrist",
            "state": "MO",
            "license": "2003015589",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in O'Fallon, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 20, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.