Central Illinois Vision Associates LTD

Primary specialty

OptometristTaxonomy code 152W00000X

License

046008347 Issued in IL

Legal business name

CENTRAL ILLINOIS VISION ASSOCIATES LTD

Practice address

620 6TH St
Charleston, IL 61920-2017

Phone

(217) 348-0800

Fax

(217) 348-0802

NPI assigned

Feb 3, 2009

Last updated

Jan 9, 2019By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. Scott ClarkeNPI 1336209055

Title

Officer

Phone

(217) 348-0800

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in IL

Enrollment records 1

Locations

Practitioners 1

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.

• Scott A Clarke, O.D.

  • Optometrist
  • Charleston, IL
  • NPI 1336209055
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1233619200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1546992000000",
    "number": "1649418385",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "620 6TH ST",
            "city": "CHARLESTON",
            "state": "IL",
            "postal_code": "619202017",
            "telephone_number": "217-348-0800",
            "fax_number": "217-348-0802"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "620 6TH ST",
            "city": "CHARLESTON",
            "state": "IL",
            "postal_code": "619202017",
            "telephone_number": "217-348-0800",
            "fax_number": "217-348-0802"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CENTRAL ILLINOIS VISION ASSOCIATES LTD",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-02-03",
        "last_updated": "2019-01-09",
        "status": "A",
        "authorized_official_last_name": "CLARKE",
        "authorized_official_first_name": "SCOTT",
        "authorized_official_title_or_position": "OFFICER",
        "authorized_official_telephone_number": "217-348-0800",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "IL",
            "license": "046008347",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Central East Alcoholism and Drug Council
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• Central Illinois Autism Therapeutic Services, NFP
• Central Illinois Developmental Therapy, Inc.
• Charleston Chiropractic Center LLC
• Charleston Community Unit School District #1
• Charleston Estates, LLC
• Charleston Hco LLC (Charleston Rehab & Health Care Center)
• Charleston Hco LLC (Charleston Rehab & Health Care Center)

• Optometrist in Charleston, IL
• Providers in Charleston, IL by specialty
• Optometrist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 9, 2019; 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.