Organization Active NPI

Heitz Optical Inc

  • Optician
  • Alton, IL
National Provider Identifier
1114095312
Registry record updated Jan 8, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
OpticianTaxonomy code 156FX1800X
License
1645-6246 Issued in IL
Legal business name
HEITZ OPTICAL INC
Practice address
2415 Homer M Adams Pkwy
Alton, IL 62002-5615
Phone
(618) 465-1712
Fax
(618) 465-3114
NPI assigned
Dec 4, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 8, 2013

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

Authorized official

Name
Mr. Drew Rinacke
Title
Owner
Phone
(618) 465-1712

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
OpticianGroup: 193400000X SINGLE SPECIALTY GROUP 156FX1800X 1645-6246 IL Primary

Addresses

Primary practice location

2415 Homer M Adams Pkwy
Alton, IL 62002-5615

Mailing address

2415 Homer M Adams Pkwy
P.O. Box 598
Alton, IL 62002-5615
Phone (618) 465-1712

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20140113000406 IL Part B Supplier - Clinic/Group Practice 7416074448 Receives reassigned benefits from 1 practitioner
Practice locations: Alton, IL

National Provider Directory

National Provider Directory

Locations

2415 Homer M Adams Pkwy
Alton, IL 62002
Phone (618) 465-1712

Practitioners & affiliated clinicians

Practitioners 1

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

NPI Registry JSON

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

{
    "created_epoch": "1165190400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1357603200000",
    "number": "1114095312",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2415 HOMER M ADAMS PKWY",
            "address_2": "P.O. BOX 598",
            "city": "ALTON",
            "state": "IL",
            "postal_code": "620025615",
            "telephone_number": "618-465-1712",
            "fax_number": "618-465-3114"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2415 HOMER M ADAMS PKWY",
            "city": "ALTON",
            "state": "IL",
            "postal_code": "620025615",
            "telephone_number": "618-465-1712",
            "fax_number": "618-465-3114"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HEITZ OPTICAL INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-04",
        "last_updated": "2013-01-08",
        "status": "A",
        "authorized_official_last_name": "RINACKE",
        "authorized_official_first_name": "DREW",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "618-465-1712",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "156FX1800X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Technician/Technologist, Optician",
            "state": "IL",
            "license": "1645-6246",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Alton, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 8, 2013; 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.