Decatur Eyecare Associates

Primary specialty

OptometristTaxonomy code 152W00000X

License

467080 Issued in IL

Legal business name

DECATUR EYECARE ASSOCIATES

Practice address

1270 S Jasper St
Decatur, IL 62521-3531

Phone

(217) 422-8032

NPI assigned

Jun 19, 2008

Organization subpart

No

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

Authorized official

Name

Dr. Charles E Bedford, OD

Title

Optometrist/Owner

Phone

(217) 422-8032

Specialties & licenses 1

Addresses

Other identifiers 5

Locations

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

{
    "created_epoch": "1213833600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1213833600000",
    "number": "1053572255",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1270 S JASPER ST",
            "city": "DECATUR",
            "state": "IL",
            "postal_code": "625213531",
            "telephone_number": "217-422-8032"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1270 S JASPER ST",
            "city": "DECATUR",
            "state": "IL",
            "postal_code": "625213531",
            "telephone_number": "217-422-8032"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DECATUR EYECARE ASSOCIATES",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-06-19",
        "last_updated": "2008-06-19",
        "status": "A",
        "authorized_official_last_name": "BEDFORD",
        "authorized_official_first_name": "CHARLES",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "OPTOMETRIST/OWNER",
        "authorized_official_telephone_number": "217-422-8032",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "IL",
            "license": "467080",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE ID",
            "identifier": "714680",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DMERC MEDICARE",
            "identifier": "4095740001",
            "state": "IL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "046007080",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS AND SHIELD OF ILLINOIS",
            "identifier": "0005884011",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "410017583",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Optometrist in Decatur, IL
• Providers in Decatur, IL by specialty
• Optometrist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 19, 2008; 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.