International Eyecare Center, Inc

Primary specialty

OptometristTaxonomy code 152W00000X

Legal business name

INTERNATIONAL EYECARE CENTER, INC

Practice address

1877A N Bluff St
Fulton, MO 65251-2465

Phone

(573) 592-7484

NPI assigned

Apr 14, 2010

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

Credentiailing Manager

Phone

(618) 462-9818

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in MO

Enrollment records 1

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

• International Eyecare Center LLC

  • Optometrist
  • Quincy, IL
  • NPI 1760405047

  O20050208000641

  Same enrollment

Locations

Practitioners 1

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

• Jill Denise Smith Radkowiec, OD

  • Optometrist
  • California, MO
  • NPI 1114239092
  NPD

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

{
    "created_epoch": "1271203200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1611273600000",
    "number": "1235455320",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1877 N BLUFF ST",
            "address_2": "A",
            "city": "FULTON",
            "state": "MO",
            "postal_code": "652512465",
            "telephone_number": "573-592-7484"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1877A N BLUFF ST",
            "city": "FULTON",
            "state": "MO",
            "postal_code": "652512465",
            "telephone_number": "573-592-7484"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INTERNATIONAL EYECARE CENTER, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-04-14",
        "last_updated": "2021-01-22",
        "certification_date": "2021-01-22",
        "status": "A",
        "authorized_official_last_name": "SHORT",
        "authorized_official_first_name": "CATHY",
        "authorized_official_middle_name": "LEE",
        "authorized_official_title_or_position": "CREDENTIAILING 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
        },
        {
            "code": "332H00000X",
            "taxonomy_group": "",
            "desc": "Eyewear Supplier",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jennifer Hrebar-Ihler
• Deirdre Leanne Huenneke, LMT
• David Robert Hunter, MD
• Kirsten Deming Hunter
• Jesse W. Hurd, RPH
• Rezwan Islam, M.D.
• Gregory Keith Ivins, M.D.
• Cheryl Ann Jackson, RPH
• Kara Beth Jaegers, R.D. L.D
• James M. McCall, D.D.S., P.C.

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

• 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.
• 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.