International Eyecare Center, Inc

Primary specialty

OptometristTaxonomy code 152W00000X

Legal business name

INTERNATIONAL EYECARE CENTER, INC

Practice address

215 Progress Rd
Hannibal, MO 63401-6637

Phone

(573) 248-1616

NPI assigned

Jan 22, 2008

Organization subpart

No

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

Authorized official

Name

Cathy Lee Short

Title

Credentialing Manager

Phone

(618) 462-9818

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1200960000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1611100800000",
    "number": "1124205166",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2445 BROADWAY ST",
            "city": "QUINCY",
            "state": "IL",
            "postal_code": "623013257",
            "telephone_number": "217-592-3906"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "215 PROGRESS RD",
            "city": "HANNIBAL",
            "state": "MO",
            "postal_code": "634016637",
            "telephone_number": "573-248-1616"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INTERNATIONAL EYECARE CENTER, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-01-22",
        "last_updated": "2021-01-20",
        "certification_date": "2021-01-20",
        "status": "A",
        "authorized_official_last_name": "SHORT",
        "authorized_official_first_name": "CATHY",
        "authorized_official_middle_name": "LEE",
        "authorized_official_title_or_position": "CREDENTIALING MANAGER",
        "authorized_official_telephone_number": "618-462-9818"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Justin Imhof, D.O.
• Kevin B Imhof, D.O.
• Emma Inglis
• Amanda M Ingram, RN
• Integrated Dermatology of Northeast Missouri LLC
• International Eyecare Center, Inc.
• Viacheslav Iremashvili, M.D.
• Jackson Group Home LLC
• Jackson Group Home LLC
• Darryl Raynor Jackson Jr.

• Optometrist in Hannibal, MO
• Providers in Hannibal, MO by specialty
• Optometrist in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 20, 2021; 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.