Ideal Eye Surgery LLC
Organization Active NPI Ophthalmology Physician · O Fallon, IL
NPI 1366966186 · NPPES record last updated Oct 16, 2025
Key facts
- NPI
- 1366966186
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Ophthalmology Physician 207W00000X
- License
- 036.141217 (IL)
- Legal business name
- IDEAL EYE SURGERY LLC
- Practice address
- 705 Insight Ave
O Fallon, IL 62269-2146 - Phone
- (618) 391-1660
- Fax
- (618) 861-6003
- NPI assigned
- Aug 2, 2017
- Organization subpart
- No
Authorized official
- Name
- Dr. Michael Vincent Stock, M.D.
- Title
- Owner
- Phone
- (618) 391-1660
Practitioners 23
-
Cameron Joseph Evans, D.O.
-
Wesley C Green, MD
-
Nicole Lowrey, MD, PHD
-
Whitney Marlow, M.D.
-
Jessica L. Weis, OD
-
Taylor Wolkart, OD
-
Rocio Bentivegna, MD
-
Tonya K Bourn, O.D.
-
Nancy Buchser, MD
-
Lawrence A Gans, M.D.
-
Grace L Paley, MD
-
Sharon Jick, M.D.
-
Lynn D Billhartz, PA
-
Connor Kabbes, OD
-
Nueki Naate, MD
-
Anthony R Weber, O.D.
-
Christopher Paul Weber, O.D.
-
Adam J Wolf, O.D.
-
Elliot Lawrence Korn, M.D.
-
Kevin Joseph Stock, D.D.S.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in IL, MO
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20180416000436 | IL | Part B Supplier - Clinic/Group Practice | 7315200888 |
Receives reassigned benefits from 11 practitioners Practice locations: Litchfield, IL; Taylorville, IL; Shelbyville, IL; O Fallon, IL; Nashville, IL; Greenville, IL; Effingham, IL; Charleston, IL… |
| O20200210000887 | MO | Part B Supplier - Clinic/Group Practice | 7315200888 |
Receives reassigned benefits from 11 practitioners Practice locations: Creve Coeur, MO; Saint Louis, MO |
National Provider Directory
Locations
324 5th St
Carrollton, IL 62016
1188 S State Route 157
Ste 100
Edwardsville, IL 62025
Phone (618) 692-5900
900 W Temple Ave
Bldg A104
Effingham, IL 62401
1660 Essex Way
Ste A
O Fallon, IL 62269
207 E Pleasant St
Taylorville, IL 62568
20 Progress Point Pkwy
Ste 126
O Fallon, MO 63368
Phone (314) 690-8383
12101 Woodcrest Executive Dr
Ste 150
Saint Louis, MO 63141
Phone (314) 391-9400
12400 Olive Blvd
Ste 240
Saint Louis, MO 63141
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Ophthalmology Physician |
207W00000X | 036.141217 | IL | Yes |
Addresses
Primary practice location
705 Insight Ave
O Fallon, IL 62269-2146
Mailing address
705 Insight Ave
O Fallon, IL 62269-2146
Phone (618) 391-1660
Other practice location 1
12400 Olive Blvd Ste 200
Saint Louis, MO 63141-5436
Phone (314) 391-9400
Other practice location 2
1 Professional Dr Ste 260
Alton, IL 62002-5068
Phone (618) 391-1660
Other practice location 3
12101 Woodcrest Executive Dr Ste 150
Saint Louis, MO 63141-5050
Phone (618) 391-1660
Other providers in O Fallon, IL
- Michael J Hushion
- Kennedy Taylor Huskey
- Samuel Dale Huskey
- HW Holdings
- Vicky Hwang
- Illinois Mentor
- Infinity-Meds LLP
- Infinity-Meds LLP
- Innovation Dental and Implant LLC
- Integrity Chiropractic and Rehabilitation, LLC
All providers in O Fallon, IL · Ophthalmology Physician in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 16, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.