Active NPI
Mid-State Eye Partners Inc
- Optometrist
- Shelbyville, IL
National Provider Identifier
1487005484
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 046010631
- Legal business name
- MID-STATE EYE PARTNERS INC
- Practice address
- 102 N Heinlein Dr
Shelbyville, IL 62565-9050 - Phone
- (217) 774-4422
- Fax
- (217) 772-4722
- NPI assigned
- Jun 30, 2016
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Dr. Bradley Stewart Grant, O.D.
- Title
- Optometrist
- Phone
- (217) 774-4422
Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 046010631 | IL | Primary |
Addresses
Primary practice location
102 N Heinlein Dr
Shelbyville, IL 62565-9050
Mailing address
90 Clubview PL
Decatur, IL 62521-2515
Phone (217) 772-4422
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in IL
Enrollment records 1
| 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 Practice locations: Shelbyville, IL; Decatur, IL; Clinton, IL |
Other NPIs on the same Medicare enrollment 1
NPIs listed together on one Medicare enrollment, typically parts of the same organization.
National Provider Directory
National Provider DirectoryLocations
4847 E US Route 36
Decatur, IL 62521
Phone (217) 425-3219
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": "1467244800000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1488499200000",
"number": "1487005484",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "90 CLUBVIEW PL",
"city": "DECATUR",
"state": "IL",
"postal_code": "625212515",
"telephone_number": "217-772-4422"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "102 N HEINLEIN DR",
"city": "SHELBYVILLE",
"state": "IL",
"postal_code": "625659050",
"telephone_number": "217-774-4422",
"fax_number": "217-772-4722"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "MID-STATE EYE PARTNERS INC",
"organizational_subpart": "NO",
"enumeration_date": "2016-06-30",
"last_updated": "2017-03-03",
"status": "A",
"authorized_official_last_name": "GRANT",
"authorized_official_first_name": "BRADLEY",
"authorized_official_middle_name": "STEWART",
"authorized_official_title_or_position": "OPTOMETRIST",
"authorized_official_telephone_number": "217-774-4422",
"authorized_official_name_prefix": "Dr.",
"authorized_official_credential": "O.D."
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Optometrist",
"state": "IL",
"license": "046010631",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Shelbyville, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 3, 2017; 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.