Complete Family Eyecare, PC
Organization Active NPI Optometrist · Herrin, IL
NPI 1104131168 · NPPES record last updated Jul 25, 2019
Key facts
- NPI
- 1104131168
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Optometrist 152W00000X
- License
- 046.010332 (IL)
- Legal business name
- COMPLETE FAMILY EYECARE, PC
- Practice address
- 3121 S Park Ave
Herrin, IL 62948-3785 - Phone
- (618) 942-5465
- Fax
- (618) 942-7042
- NPI assigned
- Aug 15, 2010
- Organization subpart
- No
Authorized official
- Name
- Dr. Chase A Rudolph, O.D.
- Title
- President
- Phone
- (618) 942-5465
Practitioners 5
-
Chase Aaron Rudolph, O.D.
-
Teresa Myers, O.D.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IL
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20101119000400 | IL | Part B Supplier - Clinic/Group Practice | 3274729033 |
Receives reassigned benefits from 5 practitioners Practice locations: Herrin, IL |
National Provider Directory
Locations
1241 E Walnut St
Carbondale, IL 62901
Phone (618) 529-3452
3121 S Park Ave
Herrin, IL 62948
Phone (618) 942-5465
2813 S Park Ave
Herrin, IL 62948
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist |
152W00000X | 046.010332 | IL | Yes |
Addresses
Primary practice location
3121 S Park Ave
Herrin, IL 62948-3785
Mailing address
2813 S Park Ave
Herrin, IL 62948-3700
Phone (618) 942-5465
Other providers in Herrin, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 25, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.