NPIMap

Specs Carthage

Organization Active NPI Optometrist · Carthage, IL

NPI 1114200896 · NPPES record last updated Sep 20, 2011

Key facts

NPI
1114200896
Entity type
Organization (NPI type 2)
Primary specialty
Optometrist 152W00000X
License
046.009104 (IL)
Legal business name
SPECS CARTHAGE
Practice address
514 Wabash Ave
Carthage, IL 62321-1360
Phone
(217) 357-9750
Fax
(217) 214-9437
NPI assigned
Sep 20, 2011
Organization subpart
No

Authorized official

Name
Mr. Daniel Leonard Hayden, OD
Title
Owner
Phone
(217) 357-9750

Corporate family (same tax ID) 1

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

Practitioners 3

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

National Provider Directory

Tax ID family
Specs Carthage (2 organizations share this tax ID)

Locations

195 S 36th St
Quincy, IL 62301
Phone (217) 224-7732

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist
Group: 193400000X SINGLE SPECIALTY GROUP		 152W00000X 046.009104 IL Yes

Addresses

Primary practice location

514 Wabash Ave
Carthage, IL 62321-1360

Mailing address

195 S 36TH St
Quincy, IL 62301-5801
Phone (217) 224-7732

Other names

  • Superior Performance Eye Care Specialist Other name

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Sep 20, 2011.

{
    "created_epoch": "1316476800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1316476800000",
    "number": "1114200896",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "195 S 36TH ST",
            "city": "QUINCY",
            "state": "IL",
            "postal_code": "623015801",
            "telephone_number": "217-224-7732",
            "fax_number": "217-214-9437"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "514 WABASH AVE",
            "city": "CARTHAGE",
            "state": "IL",
            "postal_code": "623211360",
            "telephone_number": "217-357-9750",
            "fax_number": "217-214-9437"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SPECS CARTHAGE",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-09-20",
        "last_updated": "2011-09-20",
        "status": "A",
        "authorized_official_last_name": "HAYDEN",
        "authorized_official_first_name": "DANIEL",
        "authorized_official_middle_name": "LEONARD",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "217-357-9750",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "IL",
            "license": "046.009104",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Superior Performance Eye Care Specialist",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Carthage, IL

All providers in Carthage, IL · Optometrist in Illinois

Sources for this page

Verify at the official NPI Registry.