Mid-State Eye Partners Inc

Primary specialty

OptometristTaxonomy code 152W00000X

Legal business name

MID-STATE EYE PARTNERS INC

Practice address

125 W Main St
Clinton, IL 61727-1611

Phone

(217) 935-9451

NPI assigned

Feb 19, 2019

Last updated

Feb 19, 2019By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Bradley Stewart Grant, ODNPI 1386836518

Title

Owner

Phone

(217) 935-9451

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in IL

Enrollment records 1

Other NPIs on the same Medicare enrollment 1

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

• Mid-State Eye Partners Inc

  • Optometrist
  • Shelbyville, IL
  • NPI 1487005484

  O20161108001130

  Same enrollment

Tax ID family

Mid-State Eye Partners Inc2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

• Mid-State Eye Partners Inc

  • Optometrist
  • Decatur, IL
  • NPI 1023630787
  NPD tax ID

Locations

Practitioners 4

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.

• Bradley Stewart Grant, O.D.

  • Optometrist
  • Bloomington, IL
  • NPI 1386836518
  NPD Authorized official
• Jason A Dunn, O.D.

  • Optometrist
  • Normal, IL
  • NPI 1346538154
  NPD
• Elsie Rodriguez, OD

  • Optometrist
  • Clinton, IL
  • NPI 1518743913
  NPD
• Paige A Reese, OD

  • Optometrist
  • Antioch, TN
  • NPI 1205357563
  NPD

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

{
    "created_epoch": "1550534400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1550534400000",
    "number": "1396201836",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "102 N HEINLEIN DR",
            "city": "SHELBYVILLE",
            "state": "IL",
            "postal_code": "625659050",
            "telephone_number": "217-774-4422"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "125 W MAIN ST",
            "city": "CLINTON",
            "state": "IL",
            "postal_code": "617271611",
            "telephone_number": "217-935-9451"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MID-STATE EYE PARTNERS INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-02-19",
        "last_updated": "2019-02-19",
        "status": "A",
        "authorized_official_last_name": "GRANT",
        "authorized_official_first_name": "BRADLEY",
        "authorized_official_middle_name": "STEWART",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "217-935-9451",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Pamela Lyn Letzkus, PHARM.D
• Jaycie N Liebendorfer, APRN, CNP
• Lifeway Behavioral Health Services Inc.
• Morgan Andrea Massey, APRN, CNP
• Christopher Pratt Mecherle
• Amanda Miller, RDH, PHDH
• Natasha Rae Minnaert, D.O.
• Monica E. Misthal, COTA/L, CDP, CDS
• Chelsey Shantelle Morris, RDH, PHDH
• Paramedic Services of Illinois Inc,

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 19, 2019; 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.