Central Illinois Family Eyecare LLC

Primary specialty

OptometristTaxonomy code 152W00000X

License

046-007731 Issued in IL

Legal business name

CENTRAL ILLINOIS FAMILY EYECARE LLC

Practice address

4203 N Sheridan Rd
Ste A1-4
Peoria, IL 61614-7170

Phone

(309) 686-0763

Fax

(309) 685-8809

NPI assigned

Mar 10, 2017

Organization subpart

No

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

Authorized official

Name

Dr. Dennis M Brtva, OD

Title

Owner

Phone

(309) 686-0763

Specialties & licenses 1

Addresses

Other names 1

• Peoria Eye Professionals Doing business as

Medicare fee-for-service enrollment

Enrolled in IL

Enrollment records 1

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

• Central Illinois Family Eyecare LLC

  • Optometrist
  • Bloomington, IL
  • NPI 1881135853

  O20170327000707

  Same enrollment

Tax ID family

Central Illinois Family Eyecare LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Central Illinois Family Eyecare LLC

  • Optometrist
  • Bloomington, IL
  • NPI 1881135853
  NPD tax ID

Locations

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

• Central Illinois Family Eyecare LLC

  • Optometrist
  • Bloomington, IL
  • NPI 1881135853
  NPPES parent name

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Ashley Foster, OD

  • Optometrist
  • Bloomington, IL
  • NPI 1396399374
  NPD
• Kerry Howard Head, OD

  • Optometrist
  • Kewanee, IL
  • NPI 1902993652
  NPD
• Erica Danielle Bennehoff, O.D.

  • Optometrist
  • Hanover, MD
  • NPI 1346228665
  NPD (past)
• Kyle D Mayginnes, O.D.

  • Optometrist
  • Marysville, OH
  • NPI 1700867652
  NPD (past)

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

{
    "created_epoch": "1489104000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1643155200000",
    "number": "1053852020",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7815 N KNOXVILLE AVE STE 1A",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616142022",
            "telephone_number": "309-839-1614",
            "fax_number": "309-839-8874"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4203 N SHERIDAN RD",
            "address_2": "STE A1-4",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616147170",
            "telephone_number": "309-686-0763",
            "fax_number": "309-685-8809"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CENTRAL ILLINOIS FAMILY EYECARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-03-10",
        "last_updated": "2022-01-26",
        "certification_date": "2022-01-26",
        "status": "A",
        "authorized_official_last_name": "BRTVA",
        "authorized_official_first_name": "DENNIS",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "309-686-0763",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "IL",
            "license": "046-007731",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Peoria Eye Professionals",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Peoria Eye Professionals",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 26, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.