Illinois Eye Associates LTD
Organization Active NPI Optometrist · Manhattan, IL
NPI 1770660441 · NPPES record last updated Sep 17, 2012
Key facts
- NPI
- 1770660441
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Optometrist 152W00000X
- License
- 046-009714 (IL)
- Legal business name
- ILLINOIS EYE ASSOCIATES LTD
- Practice address
- 540 W North St
Suite 209
Manhattan, IL 60442-8201 - Phone
- (815) 478-0100
- Fax
- (815) 478-9100
- NPI assigned
- Nov 1, 2006
- Organization subpart
- No
Authorized official
- Name
- Dr. Jeffrey M Pietrzyk, O.D.
- Title
- President
- Phone
- (815) 478-0100
Other NPIs on the same Medicare enrollment 1
Other NPIs with the same Medicare PAC ID 1
Corporate family (same tax ID) 1
Practitioners 3
-
Christa D Pietrzyk, O.D.
-
Lindsey B Rector, OD
Laboratory certificates & supplier records
Medicare medical equipment & supply locations
| Supplier | Supplies | Medicare assignment |
|---|---|---|
| Illinois Eye Associates |
Prosthetic Lenses: Conventional Eyeglasses|Prosthetic Lenses: Conventional Contact Lenses | Accepts assignment |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in IL
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20060306000462 | IL | Part B Supplier - Clinic/Group Practice | 1153337779 |
Receives reassigned benefits from 3 practitioners 1 other NPI on this enrollment Practice locations: Peotone, IL; Manhattan, IL |
| O20100930081797 | IL | DME Supplier - Physician - Optometrist | 1153337779 | Practice locations: Manhattan, IL |
National Provider Directory
- Tax ID family
- Illinois Eye Associates
Locations
540 W North St
Ste 209
Manhattan, IL 60442
Phone (815) 478-0100
Interoperability endpoints
- jpietrzyk@iea.intellechartdirect.net
- lrector@iea.intellechartdirect.net
- cpietrzyk@iea.intellechartdirect.net
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist |
152W00000X | 046-009714 | IL | Yes |
Addresses
Primary practice location
540 W North St
Suite 209
Manhattan, IL 60442-8201
Mailing address
540 W North St
Suite 209
Manhattan, IL 60442-8201
Phone (815) 478-0100
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| DE7499 | Other | RAILROAD MEDICARE |
Other providers in Manhattan, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 17, 2012. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.