NPIMap

Organization Active NPI

Gailey Eye Clinic, LTD

  • Ophthalmic Technician/Technologist
  • Peoria, IL
National Provider Identifier
1275738908
Registry record updated May 28, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ophthalmic Technician/TechnologistTaxonomy code 156FX1100X
License
042000963 Issued in IL
Legal business name
GAILEY EYE CLINIC, LTD
Practice address
4927 N Glen Park Place Rd
Peoria, IL 61614-4676
Phone
(309) 692-8460
NPI assigned
Jun 21, 2007
Last updated
May 28, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 28, 2008

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

Authorized official

Name
Rebecca Cox
Title
Administrative Assistant
Phone
(309) 829-5311

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Ophthalmic Technician/Technologist 156FX1100X 042000963 IL Primary

Addresses

Primary practice location

4927 N Glen Park Place Rd
Peoria, IL 61614-4676

Mailing address

4927 N Glen Park Place Rd
Peoria, IL 61614-4676
Phone (309) 692-8460

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040802000570 IL Part B Supplier - Clinic/Group Practice 2769469337 Receives reassigned benefits from 23 practitioners
5 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Peoria, IL; Watseka, IL; Springfield, IL; Peru, IL; Pekin, IL; Ottawa, IL; Galesburg, IL; Forsyth, IL…

Other NPIs on the same Medicare enrollment 5

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

National Provider Directory

National Provider Directory
Tax ID family
Invalid Entry5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

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

Locations

1008 N Main St
Bloomington, IL 61701
Phone (309) 829-5311

2501 E College Ave
Ste B
Bloomington, IL 61704
Phone (309) 661-9191

646 W Pershing Rd
Decatur, IL 62526
Phone (217) 875-0300

834 N Seminary St
Ste 103
Galesburg, IL 61401
Phone (309) 343-6000

220 E 1st St
Gibson City, IL 60936
Phone (217) 784-4912

4100 Veterans Dr
Ottawa, IL 61350
Phone (815) 434-4200

818 La Salle St
#2
Ottawa, IL 61350
Phone (815) 434-4200

107 W Water St
Pontiac, IL 61764
Phone (815) 844-2022

1401 S Koke Mill Rd
Springfield, IL 62711
Phone (217) 529-3937

123 N 8th St
Watseka, IL 60970
Phone (815) 432-2020

Practitioners & affiliated clinicians

Practitioners 24

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.

View all 24

NPI Registry JSON

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

{
    "created_epoch": "1182384000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1211932800000",
    "number": "1275738908",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4927 N GLEN PARK PLACE RD",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616144676",
            "telephone_number": "309-692-8460"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4927 N GLEN PARK PLACE RD",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616144676",
            "telephone_number": "309-692-8460"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GAILEY EYE CLINIC, LTD",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-06-21",
        "last_updated": "2008-05-28",
        "status": "A",
        "authorized_official_last_name": "COX",
        "authorized_official_first_name": "REBECCA",
        "authorized_official_title_or_position": "ADMINISTRATIVE ASSISTANT",
        "authorized_official_telephone_number": "309-829-5311"
    },
    "taxonomies": [
        {
            "code": "156FX1100X",
            "taxonomy_group": "",
            "desc": "Technician/Technologist, Ophthalmic",
            "state": "IL",
            "license": "042000963",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Peoria, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 28, 2008; 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.