NPIMap

Organization Active NPI

Specs Carthage

  • Optometrist
  • Carthage, IL
National Provider Identifier
1114200896
Registry record updated Sep 20, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
046.009104 Issued in 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
Last updated
Sep 20, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 20, 2011

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

Authorized official

Name
Mr. Daniel Leonard Hayden, ODNPI 1821047994
Title
Owner
Phone
(217) 357-9750

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193400000X SINGLE SPECIALTY GROUP 152W00000X 046.009104 IL Primary

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 1

  • Superior Performance Eye Care Specialist Other name

National Provider Directory

National Provider Directory
Tax ID family
Specs Carthage2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

Practitioners & affiliated clinicians

Practitioners 4

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.

NPI Registry JSON

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

{
    "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

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 20, 2011; 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.