Eye Surgical Associates SC

Primary specialty

Ophthalmology PhysicianTaxonomy code 207W00000X

License

042006101 Issued in IL

Legal business name

EYE SURGICAL ASSOCIATES SC

Practice address

1505 Eastland Dr
Suite 2200
Bloomington, IL 61701-3534

Phone

(309) 662-7700

Fax

(309) 662-0829

NPI assigned

Jun 24, 2006

Organization subpart

No

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

Authorized official

Name

Dr. Edward L Colloton, MDNPI 1023012614

Title

Doctor

Phone

(309) 662-7700

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

Practitioners 1

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

• Edward Leslie Colloton, MD

  • Ophthalmology Physician
  • Bloomington, IL
  • NPI 1023012614
  NPD (past) Authorized official

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

{
    "created_epoch": "1151107200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1272412800000",
    "number": "1396771002",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1505 EASTLAND DR",
            "address_2": "SUITE 2200",
            "city": "BLOOMINGTON",
            "state": "IL",
            "postal_code": "617013534",
            "telephone_number": "309-662-7700",
            "fax_number": "309-662-0829"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1505 EASTLAND DR",
            "address_2": "SUITE 2200",
            "city": "BLOOMINGTON",
            "state": "IL",
            "postal_code": "617013534",
            "telephone_number": "309-662-7700",
            "fax_number": "309-662-0829"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EYE SURGICAL ASSOCIATES SC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-24",
        "last_updated": "2010-04-28",
        "status": "A",
        "authorized_official_last_name": "COLLOTON",
        "authorized_official_first_name": "EDWARD",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "DOCTOR",
        "authorized_official_telephone_number": "309-662-7700",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Ophthalmology",
            "state": "IL",
            "license": "042006101",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BC/BS PROV #",
            "identifier": "005700231",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Keith Allen Evans, D.M.D., M.S.
• Lakeshia Evans
• Rebecca Evans, MSOT, OTR/L
• Yvette Evans, SLP
• Everside Health, LLC
• Eyecare Associates, LLP
• Stella Uju Eze
• Erin Marlene Fabish, M.S.
• Sandra A Fader, APN
• Katharine Fagan-Nelson, LCSW

• Ophthalmology Physician in Bloomington, IL
• Providers in Bloomington, IL by specialty
• Ophthalmology Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 28, 2010; 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.