Aeg Kentucky Professional, PLLC
Organization Active NPI Optometrist · Alton, IL
NPI 1467214080 · NPPES record last updated Jun 20, 2024
Key facts
- NPI
- 1467214080
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Optometrist 152W00000X
- Legal business name
- AEG KENTUCKY PROFESSIONAL, PLLC
- Practice address
- 111 E 4TH St Ste 440
Alton, IL 62002-6206 - Phone
- (618) 462-9818
- Fax
- (314) 741-4947
- NPI assigned
- Jan 29, 2024
- Organization subpart
- No
Authorized official
- Name
- Benjamin Chudner
- Title
- Owner
- Phone
- (314) 741-8183
Practitioners 22
-
Mary Jo Baize-Moore, O.D.
-
Robert A. Hamilton, D.O.
-
Davea Adams Horton, O.D.
-
Reed Jarvis, O.D.
-
Ashley Lockman, OD
-
Elizabeth Mauzy Martin, O.D.
-
Steven H Shake, O.D.
-
Stuart Henry Shake, O.D.
-
Marty Shane Traylor, O.D.
-
Jesse Carl Williams, O.D.
-
Christopher Scott Meyer, O.D.
-
Joseph Allan Pruitt, O.D.
-
Barbara Van, OD
-
Michael S. Shields, D.O.
-
John C Schertzinger, O.D.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in KY
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20240823001822 | KY | Part B Supplier - Clinic/Group Practice | 6204375165 |
Receives reassigned benefits from 17 practitioners Practice locations: Henderson, KY; Murray, KY; Owensboro, KY |
National Provider Directory
Locations
1806 N 4th St
Murray, KY 42071
Phone (270) 638-9619
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist |
152W00000X | Yes |
Addresses
Primary practice location
111 E 4TH St Ste 440
Alton, IL 62002-6206
Mailing address
111 E 4TH St Ste 440
Alton, IL 62002-6206
Phone (618) 462-9818
Other providers in Alton, IL
- Florence Oluwadamilola Adeyemo
- Advanced Wellness Chiropractic and Functional Rehab LLC
- Aeg Connecticut Professional PLLC
- Aeg Delaware Professional PA
- Aeg Delaware Professional PA
- Aeg Louisiana Professional PC
- Aeg Washington DC Professional PLLC
- Affordable Dentistry Today, PC
- Meriban Ahmadova
- Jennifer Aiken
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 20, 2024. 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.