Optometric Eyecare, Inc

Primary specialty

OptometristTaxonomy code 152W00000X

License

046-008793 Issued in IL

Legal business name

OPTOMETRIC EYECARE, INC

Doing business as

Olney EyeCare

Practice address

303 E Main St
Olney, IL 62450

Phone

(618) 395-2676

NPI assigned

Dec 18, 2008

Organization subpart

Yes

Parent organization

OPTOMETRIC EYECARE, INCAs reported in NPPES

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

Authorized official

Name

Dr. Clark Edward Deshon, OD, FAAO

Title

President

Phone

(618) 395-2676

Specialties & licenses 1

Addresses

Other names 1

• Olney EyeCare Doing business as

Medicare fee-for-service enrollment

Enrolled in IL

Enrollment records 1

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

• Optometric Eyecare Inc.

  • Optometrist
  • Olney, IL
  • NPI 1609041342

  6002975596

  Same PAC ID

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Tax ID family

Mt Carmel Eyecare3 organizations share this tax ID, including this one

Part of

Mt Carmel Eyecare

Other organizations with this tax ID 2

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

• Mt Carmel Eyecare

  • Eyewear Supplier
  • Mount Carmel, IL
  • NPI 1790924884
  NPD tax ID
• Optometric Eyecare Inc.

  • Optometrist
  • Olney, IL
  • NPI 1609041342
  NPD tax ID

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

• Optometric Eyecare Inc.

  • Optometrist
  • Olney, IL
  • NPI 1609041342
  NPPES parent name

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

{
    "created_epoch": "1229558400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1535673600000",
    "number": "1376789578",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "303 E MAIN ST",
            "city": "OLNEY",
            "state": "IL",
            "postal_code": "624502117",
            "telephone_number": "618-395-2676"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "303 E MAIN ST",
            "city": "OLNEY",
            "state": "IL",
            "postal_code": "62450",
            "telephone_number": "618-395-2676"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OPTOMETRIC EYECARE, INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "OPTOMETRIC EYECARE, INC",
        "enumeration_date": "2008-12-18",
        "last_updated": "2018-08-31",
        "status": "A",
        "authorized_official_last_name": "DESHON",
        "authorized_official_first_name": "CLARK",
        "authorized_official_middle_name": "EDWARD",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "618-395-2676",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "OD, FAAO"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "IL",
            "license": "046-008793",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Olney EyeCare",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Olney EyeCare",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Olney Acquisitions I Inc
• Olney Estates, LLC
• Olney Eyecare
• One Hope United
• Optometric Eyecare Inc.
• Justin Michael Orenich, D.O.
• Lindsay Overton
• William R Padgett Jr., MD
• Valerie Nicole Pampe, SLP
• Parth R Patel

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 31, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• 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.