Eye Specialist of Southern Illinois, LLC

Primary specialty

Ophthalmology PhysicianTaxonomy code 207W00000X

Legal business name

EYE SPECIALIST OF SOUTHERN ILLINOIS, LLC

Practice address

1000 W Deyoung St
Marion, IL 62959-1630

Phone

(618) 993-0068

Fax

(618) 993-0968

NPI assigned

Apr 5, 2006

Organization subpart

No

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

Authorized official

Name

David C Anderson

Title

Practice Administrator

Phone

(573) 335-9175

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Kies Eye Center Doing business as

Practitioners 2

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

• Brent Ryan Davidson, M.D.

  • Ophthalmology Physician
  • Fenton, MO
  • NPI 1437127065
  NPD (past)
• Richard L. Kies, M.D.

  • Ophthalmology Physician
  • Cape Girardeau, MO
  • NPI 1942278916
  NPD (past)

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

{
    "created_epoch": "1144195200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1191369600000",
    "number": "1528020401",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1429 N MOUNT AUBURN RD",
            "city": "CAPE GIRARDEAU",
            "state": "MO",
            "postal_code": "637012171",
            "telephone_number": "573-335-9175",
            "fax_number": "573-334-3390"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1000 W DEYOUNG ST",
            "city": "MARION",
            "state": "IL",
            "postal_code": "629591630",
            "telephone_number": "618-993-0068",
            "fax_number": "618-993-0968"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EYE SPECIALIST OF SOUTHERN ILLINOIS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-04-05",
        "last_updated": "2007-10-03",
        "status": "A",
        "authorized_official_last_name": "ANDERSON",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "PRACTICE ADMINISTRATOR",
        "authorized_official_telephone_number": "573-335-9175"
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Ophthalmology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUECROSS BLUESHIELD",
            "identifier": "10032015",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "CK8965",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Kies Eye Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Janelle Evans
• Mindi Lynn Evans
• Samantha Elizabeth Evans, RN
• Everside Health, LLC
• Elizabeth Hope Eversmann, FNP-C
• Eyemart Express LLC
• Krista Kay Falaster, LPN
• Shelley Falik, MD
• Kittie Michelle Falmier, MSW, LSW
• Lindsey Falmier, LCSW

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 3, 2007; 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.