NPIMap

Organization Active NPI

Greenville Eyeglass & Contacts Inc

  • Optometrist
  • Greenville, IL
National Provider Identifier
1104926674
Registry record updated Nov 26, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
Legal business name
GREENVILLE EYEGLASS & CONTACTS INC
Practice address
216 N Third St
Ste B
Greenville, IL 62246-1004
Phone
(618) 664-9101
Fax
(618) 664-9657
NPI assigned
Sep 25, 2006
Last updated
Nov 26, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 26, 2008

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

Authorized official

Name
Amy Lile
Title
Office Manager
Phone
(618) 664-9101

Specialties & licenses 1

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

Addresses

Primary practice location

216 N Third St
Ste B
Greenville, IL 62246-1004

Mailing address

216 N Third St
Ste B
Greenville, IL 62246-1004
Phone (618) 664-9101

Other identifiers 3

IdentifierTypeStateIssuer
1235122466MedicaidIL
1265504443MedicaidIL
1104926674OtherILNPI

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20051114000117 IL Part B Supplier - Clinic/Group Practice 3678592268 Receives reassigned benefits from 14 practitioners
Practice locations: Greenville, IL

National Provider Directory

National Provider Directory

Locations

210 W Main St
Greenville, IL 62246
Phone (618) 664-9101

216 N 3rd St
#B
Greenville, IL 62246
Phone (618) 664-9101

216B N 3rd St
Greenville, IL 62246
Phone (618) 664-9101

Practitioners & affiliated clinicians

Practitioners 15

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 15

NPI Registry JSON

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

{
    "created_epoch": "1159142400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1227657600000",
    "number": "1104926674",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "216 N THIRD ST",
            "address_2": "STE B",
            "city": "GREENVILLE",
            "state": "IL",
            "postal_code": "622461004",
            "telephone_number": "618-664-9101",
            "fax_number": "618-664-9657"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "216 N THIRD ST",
            "address_2": "STE B",
            "city": "GREENVILLE",
            "state": "IL",
            "postal_code": "622461004",
            "telephone_number": "618-664-9101",
            "fax_number": "618-664-9657"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREENVILLE EYEGLASS & CONTACTS INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-25",
        "last_updated": "2008-11-26",
        "status": "A",
        "authorized_official_last_name": "LILE",
        "authorized_official_first_name": "AMY",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "618-664-9101"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1235122466",
            "state": "IL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1265504443",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1104926674",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Greenville, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 26, 2008; 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.