Superior Performance Eye Care Specialst

Primary specialty

OptometristTaxonomy code 152W00000X

License

IL046009104 Issued in IL

Legal business name

SUPERIOR PERFORMANCE EYE CARE SPECIALST

Doing business as

Specs Carthage

Practice address

514 Wabash Ave
Carthage, IL 62321-1360

Phone

(217) 356-9750

Fax

(217) 357-9710

NPI assigned

Aug 26, 2010

Last updated

Aug 26, 2010By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Daniel Leonard Hayden, OD

Title

Owner

Phone

(217) 357-9750

Specialties & licenses 1

Addresses

Other names 1

• Specs Carthage Doing business as

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.

• Specs Carthage

  • Optometrist
  • Carthage, IL
  • NPI 1114200896
  NPD tax ID

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

{
    "created_epoch": "1282780800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1282780800000",
    "number": "1265748354",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "514 WABASH AVE",
            "city": "CARTHAGE",
            "state": "IL",
            "postal_code": "623211360",
            "telephone_number": "217-356-9750",
            "fax_number": "217-357-9710"
        },
        {
            "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": "217-356-9750",
            "fax_number": "217-357-9710"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUPERIOR PERFORMANCE EYE CARE SPECIALST",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-08-26",
        "last_updated": "2010-08-26",
        "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_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "IL",
            "license": "IL046009104",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Specs Carthage",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Louis G. Sisto
• Bobbi Skinner
• Tiffany Smith
• Specs Carthage
• Brock Stout
• Jennifer Teel
• Tammy Sue Teel, MS ED.
• Linda S Tobias, MT-BC
• Vance Chiropractic and Wellness
• Daveda C Voss, NP

• Optometrist in Carthage, IL
• Providers in Carthage, IL by specialty
• Optometrist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 26, 2010; 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.