Illinois Express Vision Center, Mattoon Inc

Primary specialty

OptometristTaxonomy code 152W00000X

Legal business name

ILLINOIS EXPRESS VISION CENTER, MATTOON INC

Doing business as

Mt Vernon Eyecare

Practice address

3917 Broadway St
Times Square Mall
Mount Vernon, IL 62864-2290

Phone

(618) 244-5522

Fax

(618) 244-9512

NPI assigned

Feb 28, 2008

Last updated

Mar 23, 2016By 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

Amy Marie Miller

Title

Assistant Manager

Phone

(217) 235-1100

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• MT VERNON EYECARE Doing business as

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

{
    "created_epoch": "1204156800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1458691200000",
    "number": "1679742183",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "420 BROADWAY AVE E",
            "city": "MATTOON",
            "state": "IL",
            "postal_code": "619384604",
            "telephone_number": "217-235-1100",
            "fax_number": "217-235-1126"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3917 BROADWAY ST",
            "address_2": "TIMES SQUARE MALL",
            "city": "MOUNT VERNON",
            "state": "IL",
            "postal_code": "628642290",
            "telephone_number": "618-244-5522",
            "fax_number": "618-244-9512"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ILLINOIS EXPRESS VISION CENTER, MATTOON INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-02-28",
        "last_updated": "2016-03-23",
        "status": "A",
        "authorized_official_last_name": "MILLER",
        "authorized_official_first_name": "AMY",
        "authorized_official_middle_name": "MARIE",
        "authorized_official_title_or_position": "ASSISTANT MANAGER",
        "authorized_official_telephone_number": "217-235-1100"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "371279746001",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MT VERNON EYECARE",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Optometrist in Mount Vernon, IL
• Providers in Mount Vernon, IL by specialty
• Optometrist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 23, 2016; 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.