Organization Active NPI

Alliance Eyecare, Inc.

  • Optometrist
  • Bloomington, IL
National Provider Identifier
1710042643
Registry record updated Oct 16, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
Legal business name
ALLIANCE EYECARE, INC.
Practice address
1228 Towanda Ave
Bloomington, IL 61701-3469
Phone
(309) 828-7723
NPI assigned
Dec 22, 2006
Last updated
Oct 16, 2007By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 16, 2007

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

Authorized official

Name
Brenda A Russell
Title
Assistant Comptroller
Phone
(309) 828-7723

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X NU Primary

Addresses

Primary practice location

1228 Towanda Ave
Bloomington, IL 61701-3469

Mailing address

1228 Towanda Ave
Bloomington, IL 61701-3469
Phone (309) 828-7723

Other identifiers 2

IdentifierTypeStateIssuer
05732032OtherILBLUE CROSS BLUE SHIELD
4718410001OtherDMERC

National Provider Directory

National Provider Directory

Locations

1228 Towanda Ave
Bloomington, IL 61701
Phone (309) 662-3937

Practitioners & affiliated clinicians

Practitioners 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1166745600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1192492800000",
    "number": "1710042643",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1228 TOWANDA AVE",
            "city": "BLOOMINGTON",
            "state": "IL",
            "postal_code": "617013469",
            "telephone_number": "309-828-7723"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1228 TOWANDA AVE",
            "city": "BLOOMINGTON",
            "state": "IL",
            "postal_code": "617013469",
            "telephone_number": "309-828-7723"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ALLIANCE EYECARE, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-22",
        "last_updated": "2007-10-16",
        "status": "A",
        "authorized_official_last_name": "RUSSELL",
        "authorized_official_first_name": "BRENDA",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "ASSISTANT COMPTROLLER",
        "authorized_official_telephone_number": "309-828-7723"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "05732032",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DMERC",
            "identifier": "4718410001",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Bloomington, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 16, 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.