Peoria Eye Clinic, LTD

Primary specialty

Ophthalmology PhysicianTaxonomy code 207W00000X

Legal business name

PEORIA EYE CLINIC, LTD

Practice address

2422 W Nebraska Ave
Peoria, IL 61604-3112

Phone

(309) 676-2020

Fax

(309) 673-2020

NPI assigned

Nov 19, 2005

Organization subpart

No

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

Authorized official

Name

John C Nelson, MD

Title

President

Phone

(309) 676-2020

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1132358400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1366424756",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2422 W NEBRASKA AVE",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616043112",
            "telephone_number": "309-676-2020",
            "fax_number": "309-673-2020"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2422 W NEBRASKA AVE",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616043112",
            "telephone_number": "309-676-2020",
            "fax_number": "309-673-2020"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEORIA EYE CLINIC, LTD",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-11-19",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "NELSON",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "309-676-2020",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Ophthalmology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FEDERAL TAX ID NUMBER",
            "identifier": "37103572",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Ophthalmology Physician in Peoria, IL
• Providers in Peoria, IL by specialty
• Ophthalmology Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.