NPIMap

Organization Active NPI

International Eyecare Center, Inc.

  • Optometrist
  • Hannibal, MO
National Provider Identifier
1215378963
Registry record updated Jan 22, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
Legal business name
INTERNATIONAL EYECARE CENTER, INC.
Doing business as
Main Street Eye Clinic-a division of IEC
Practice address
3201 Highway 61
Suite a
Hannibal, MO 63401-6578
Phone
(573) 248-3937
Fax
(573) 221-4393
NPI assigned
Jul 10, 2013
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 22, 2021

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

Authorized official

Name
Teresa D Carter
Title
President
Phone
(217) 222-9207

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193400000X SINGLE SPECIALTY GROUP 152W00000X Primary
Eyewear Supplier 332H00000X

Addresses

Primary practice location

3201 Highway 61
Suite a
Hannibal, MO 63401-6578

Mailing address

3201 Highway 61
Suite a
Hannibal, MO 63401-6578
Phone (573) 248-3937

Other identifiers 1

IdentifierTypeStateIssuer
1760405047MedicaidMO

Other names 1

  • Main Street Eye Clinic-a division of IEC Doing business as

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1373414400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1611273600000",
    "number": "1215378963",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3201 HIGHWAY 61",
            "address_2": "SUITE A",
            "city": "HANNIBAL",
            "state": "MO",
            "postal_code": "634016578",
            "telephone_number": "573-248-3937",
            "fax_number": "573-221-4393"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3201 HIGHWAY 61",
            "address_2": "SUITE A",
            "city": "HANNIBAL",
            "state": "MO",
            "postal_code": "634016578",
            "telephone_number": "573-248-3937",
            "fax_number": "573-221-4393"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INTERNATIONAL EYECARE CENTER, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-07-10",
        "last_updated": "2021-01-22",
        "certification_date": "2021-01-22",
        "status": "A",
        "authorized_official_last_name": "CARTER",
        "authorized_official_first_name": "TERESA",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "217-222-9207"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "332H00000X",
            "taxonomy_group": "",
            "desc": "Eyewear Supplier",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1760405047",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Main Street Eye Clinic-a division of IEC",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Main Street Eye Clinic-a division of IEC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Hannibal, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 22, 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.