NPIMap

Organization Active NPI

Family Eye Care Southpark

  • Optometrist
  • Moline, IL
National Provider Identifier
1629198585
Registry record updated Aug 11, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
1699 Issued in IA
Legal business name
FAMILY EYE CARE SOUTHPARK
Practice address
4703 16TH St
Moline, IL 61265-7066
Phone
(309) 762-3937
NPI assigned
Apr 1, 2007
Last updated
Aug 11, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 11, 2008

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

Authorized official

Name
Robert Bently Woodham
Title
Owner
Phone
(309) 762-3937

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 1699 IA Primary

Addresses

Primary practice location

4703 16TH St
Moline, IL 61265-7066

Mailing address

4703 16TH St
Moline, IL 61265-7066
Phone (309) 762-3937

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1175385600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1218412800000",
    "number": "1629198585",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4703 16TH ST",
            "city": "MOLINE",
            "state": "IL",
            "postal_code": "612657066",
            "telephone_number": "309-762-3937"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4703 16TH ST",
            "city": "MOLINE",
            "state": "IL",
            "postal_code": "612657066",
            "telephone_number": "309-762-3937"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAMILY EYE CARE SOUTHPARK",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-01",
        "last_updated": "2008-08-11",
        "status": "A",
        "authorized_official_last_name": "WOODHAM",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "BENTLY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "309-762-3937"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "IA",
            "license": "1699",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Moline, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 11, 2008; 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.