Mark A Havera, OD

Primary specialty

OptometristTaxonomy code 152W00000X

License

046010454 Issued in IL

Practice address

6663 Edwardsville Crossing Dr
Ste B
Edwardsville, IL 62025-2704

Phone

(618) 659-2320

Fax

(618) 655-0375

NPI assigned

Aug 11, 2011

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in IL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Optometry

Education

Other, 2011

Medicare assignment

May accept Medicare assignment

Group practices

Havera Eye Care Specialists LLCGroup PAC ID 2961737549, 2 clinicians

Practice addresses (Care Compare)

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: markhavera@direct.eyecare-partners.com
• Direct secure messaging: mark.havera@direct.revolutionehr.com

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Havera Eye Care Specialists LLC

  • Optometrist
  • Collinsville, IL
  • NPI 1942862214
  Medicare reassignment Care Compare group NPD Authorized official
• Clarkson Optometry Illinois, P.C.

  • Optometrist
  • Ballwin, MO
  • NPI 1548635758

  IL

  Medicare reassignment NPD
• Clarkson Optometry Illinois, P.C.

  • Optometrist
  • Centralia, IL
  • NPI 1730373648
  NPD

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

{
    "created_epoch": "1313020800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1412208000000",
    "number": "1306125166",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "40 E NORTH ST",
            "city": "EUREKA",
            "state": "MO",
            "postal_code": "630251205",
            "telephone_number": "636-200-4393",
            "fax_number": "636-938-2650"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6663 EDWARDSVILLE CROSSING DR",
            "address_2": "STE B",
            "city": "EDWARDSVILLE",
            "state": "IL",
            "postal_code": "620252704",
            "telephone_number": "618-659-2320",
            "fax_number": "618-655-0375"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HAVERA",
        "first_name": "MARK",
        "middle_name": "A",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-08-11",
        "last_updated": "2014-10-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "IL",
            "license": "046010454",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jennifer Robin Hastings
• Keli Ann Hatfield, OTR/L
• Ha Thuy Hatley, MD
• Karla M Haun, PTA
• Jennifer R Hauschild, MS, OTR/L
• Nicole Marie Hayes, LCSW
• Heather Hedrick, RN
• Jill Marie Heitzig
• Renee Held, OTR L
• Alyssa Heldak

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 2, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.