Mid-State Eye Partners Inc
Organization Active NPI Optometrist · Clinton, IL
NPI 1396201836 · NPPES record last updated Feb 19, 2019
Key facts
- NPI
- 1396201836
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Optometrist 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
- Organization subpart
- No
Authorized official
- Name
- Bradley Stewart Grant, OD
- Title
- Owner
- Phone
- (217) 935-9451
Other NPIs on the same Medicare enrollment 1
Corporate family (same tax ID) 1
Practitioners 4
-
Jason A Dunn, O.D.
-
Bradley Stewart Grant, O.D.
-
Elsie Rodriguez, OD
-
Paige A Reese, OD
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IL
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20161108001130 | IL | Part B Supplier - Clinic/Group Practice | 4385923739 |
Receives reassigned benefits from 4 practitioners 1 other NPI on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Shelbyville, IL; Decatur, IL; Clinton, IL |
National Provider Directory
- Tax ID family
- Mid-State Eye Partners Inc
Locations
102 N Heinlein Dr
Shelbyville, IL 62565
Phone (217) 774-4422
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist |
152W00000X | Yes |
Addresses
Primary practice location
125 W Main St
Clinton, IL 61727-1611
Mailing address
102 N Heinlein Dr
Shelbyville, IL 62565-9050
Phone (217) 774-4422
Other providers in Clinton, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 19, 2019. 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.