Active NPI
Mid-State Eye Partners Inc
- Optometrist
- Shelbyville, IL
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
- Last updated
- Mar 3, 2017
- 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
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
125 W Main St
Clinton, IL 61727
Phone (217) 935-9451
4847 E US Route 36
Decatur, IL 62521
Phone (217) 425-3219
102 N Heinlein Dr
Shelbyville, IL 62565
Phone (217) 774-4422
Practitioners & affiliated clinicians
Practitioners 4
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.
-
- Optometrist
- Bloomington, IL
- NPI 1386836518
-
- Optometrist
- Normal, IL
- NPI 1346538154
-
- Optometrist
- Clinton, IL
- NPI 1518743913
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.