NPIMap

Organization Active NPI

Aeg Iowa Professional PC

Doing business as International Eyecare Center -Centerville

  • Optometrist
  • Centerville, IA
National Provider Identifier
1396510038
Registry record updated Jun 20, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
Legal business name
AEG IOWA PROFESSIONAL PC
Doing business as
International Eyecare Center -Centerville
Practice address
125 N 13TH St
Centerville, IA 52544-1705
Phone
(641) 437-4099
NPI assigned
Nov 22, 2023
Organization subpart
Yes
Parent organization
AEG IOWA PROFESSIONAL PCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jun 20, 2024

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

Authorized official

Name
Dr. Abby Thomas, OD
Title
President
Phone
(314) 741-8183

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193400000X SINGLE SPECIALTY GROUP 152W00000X Primary

Addresses

Primary practice location

125 N 13TH St
Centerville, IA 52544-1705

Mailing address

111 E 4TH St Ste 440
Alton, IL 62002-6206
Phone (618) 462-9818

Other names 1

  • International Eyecare Center -Centerville Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Aeg Iowa Professional PC2 organizations share this tax ID, including this one
Part of
Aeg Iowa Professional PC

Other organizations with this tax ID 1

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

Ownership & related parties

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.

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1700611200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1718841600000",
    "number": "1396510038",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "111 E 4TH ST STE 440",
            "city": "ALTON",
            "state": "IL",
            "postal_code": "620026206",
            "telephone_number": "618-462-9818",
            "fax_number": "314-741-4947"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "125 N 13TH ST",
            "city": "CENTERVILLE",
            "state": "IA",
            "postal_code": "525441705",
            "telephone_number": "641-437-4099"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AEG IOWA PROFESSIONAL PC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "AEG IOWA PROFESSIONAL PC",
        "enumeration_date": "2023-11-22",
        "last_updated": "2024-06-20",
        "certification_date": "2024-06-20",
        "status": "A",
        "authorized_official_last_name": "THOMAS",
        "authorized_official_first_name": "ABBY",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "314-741-8183",
        "authorized_official_name_prefix": "Dr.",
        "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": [
        {
            "organization_name": "International Eyecare Center -Centerville",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "International Eyecare Center -Centerville",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Centerville, IA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 20, 2024; 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.