NPIMap

Organization Active NPI

Aeg Louisiana Professional PC

  • Optometrist
  • Alton, IL
National Provider Identifier
1629827795
Registry record updated Oct 14, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
Legal business name
AEG LOUISIANA PROFESSIONAL PC
Practice address
111 E 4TH St Ste 440
Alton, IL 62002-6206
Phone
(618) 462-9818
Fax
(314) 741-4947
NPI assigned
May 13, 2024
Last updated
Oct 14, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 14, 2025

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

Authorized official

Name
Melissa Allison
Title
Sr. Director MVC
Phone
(618) 604-5208

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X Primary

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

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in LA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20241115000039 LA Part B Supplier - Clinic/Group Practice 5799219515 Receives reassigned benefits from 11 practitioners
Practice locations: Amite, LA; Denham Springs, LA; Hammond, LA; Harvey, LA; Kenner, LA

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 13

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.

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1715558400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1760400000000",
    "number": "1629827795",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "111 E 4TH ST STE 440",
            "city": "ALTON",
            "state": "IL",
            "postal_code": "620026206",
            "telephone_number": "618-462-9818",
            "fax_number": "314-741-4947"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "111 E 4TH ST STE 440",
            "city": "ALTON",
            "state": "IL",
            "postal_code": "620026206",
            "telephone_number": "618-462-9818",
            "fax_number": "314-741-4947"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AEG LOUISIANA PROFESSIONAL PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-05-13",
        "last_updated": "2025-10-14",
        "certification_date": "2025-10-14",
        "status": "A",
        "authorized_official_last_name": "ALLISON",
        "authorized_official_first_name": "MELISSA",
        "authorized_official_title_or_position": "SR. DIRECTOR MVC",
        "authorized_official_telephone_number": "618-604-5208"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Alton, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 14, 2025; 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.

Verify at the official NPI Registry.