NPIMap

Organization Active NPI

Family Eye Care of Ofallon PC

  • Optometrist
  • O'Fallon, IL
National Provider Identifier
1801926340
Registry record updated Dec 11, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
046008375 Issued in IL
Legal business name
FAMILY EYE CARE OF OFALLON PC
Practice address
735 Insight Ave
O Fallon, IL 62269-2193
Phone
(618) 628-2903
Fax
(618) 628-2913
NPI assigned
Mar 6, 2007
Last updated
Dec 11, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 11, 2019

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

Authorized official

Name
David D ErnstNPI 1306076518
Title
Optometrist
Phone
(618) 532-1082

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193400000X SINGLE SPECIALTY GROUP 152W00000X 046008375 IL Primary

Addresses

Primary practice location

735 Insight Ave
O Fallon, IL 62269-2193

Mailing address

735 Insight Ave
O Fallon, IL 62269-2193
Phone (618) 628-2903

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20071219000451 IL Part B Supplier - Clinic/Group Practice 6204926843 Receives reassigned benefits from 5 practitioners
Practice locations: O Fallon, IL

National Provider Directory

National Provider Directory

Locations

735 Insight Ave
O Fallon, IL 62269
Phone (618) 628-2903

9 Eagle Ctr
Ste 3
O Fallon, IL 62269
Phone (618) 628-2903

Practitioners & affiliated clinicians

Practitioners 9

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": "1173139200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1576022400000",
    "number": "1801926340",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "735 INSIGHT AVE",
            "city": "O FALLON",
            "state": "IL",
            "postal_code": "622692193",
            "telephone_number": "618-628-2903",
            "fax_number": "618-628-2913"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "735 INSIGHT AVE",
            "city": "O FALLON",
            "state": "IL",
            "postal_code": "622692193",
            "telephone_number": "618-628-2903",
            "fax_number": "618-628-2913"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAMILY EYE CARE OF OFALLON PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-06",
        "last_updated": "2019-12-11",
        "certification_date": "2019-12-11",
        "status": "A",
        "authorized_official_last_name": "ERNST",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "OPTOMETRIST",
        "authorized_official_telephone_number": "618-532-1082"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "IL",
            "license": "046008375",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in O'Fallon, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 11, 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.