Eye Consultants of Il LTD

Primary specialty

Ophthalmology PhysicianTaxonomy code 207W00000X

License

03058639 Issued in IL

Legal business name

EYE CONSULTANTS OF IL LTD

Doing business as

Eye Consultants of Illinois

Practice address

12818 Tesson Ferry Rd
Suite 201
Saint Louis, MO 63128-2945

Phone

(314) 843-4044

Fax

(314) 843-2941

NPI assigned

Mar 8, 2007

Organization subpart

No

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

Authorized official

Name

Christine M McDonald

Title

Business Manager

Phone

(314) 843-4044

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Eye Consultants of Illinois Doing business as

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

{
    "created_epoch": "1173312000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1275350400000",
    "number": "1093846347",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "208 W MAIN ST",
            "city": "STAUNTON",
            "state": "IL",
            "postal_code": "620881470",
            "telephone_number": "618-635-3535",
            "fax_number": "314-843-2941"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12818 TESSON FERRY RD",
            "address_2": "SUITE 201",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631282945",
            "telephone_number": "314-843-4044",
            "fax_number": "314-843-2941"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EYE CONSULTANTS OF IL LTD",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-08",
        "last_updated": "2010-06-01",
        "status": "A",
        "authorized_official_last_name": "MCDONALD",
        "authorized_official_first_name": "CHRISTINE",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "BUSINESS MANAGER",
        "authorized_official_telephone_number": "314-843-4044"
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Ophthalmology",
            "state": "IL",
            "license": "03058639",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036058639",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Eye Consultants of Illinois",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Ophthalmology Physician in Saint Louis, MO
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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 1, 2010; 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.