Innovative Eye Care Specialists, LLC

Primary specialty

OptometristTaxonomy code 152W00000X

License

2012018551 Issued in MO

Legal business name

INNOVATIVE EYE CARE SPECIALISTS, LLC

Practice address

10275 Watson Rd
Saint Louis, MO 63127

Phone

(816) 517-3599

NPI assigned

Feb 7, 2018

Organization subpart

No

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

Authorized official

Name

Eric Jerde, ODNPI 1609121839

Title

Owner

Phone

(314) 962-9334

Specialties & licenses 1

Addresses

Other names 1

• Jerde Eye Specialists Doing business as

Medicare fee-for-service enrollment

Enrolled in MO

Enrollment records 1

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Eric Jerde, O.D.

  • Optometrist
  • Saint Louis, MO
  • NPI 1609121839

  MO, Optometrist

  Medicare reassignment NPD Authorized official
• Ashley A. Thill, O.D.

  • Optometrist
  • Springfield, MO
  • NPI 1811259518

  MO, Optometrist

  Medicare reassignment NPD

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

{
    "created_epoch": "1517961600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1532304000000",
    "number": "1821597592",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10275 WATSON RD",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631271103",
            "telephone_number": "314-962-9334"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10275 WATSON RD",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "63127",
            "telephone_number": "816-517-3599"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INNOVATIVE EYE CARE SPECIALISTS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-02-07",
        "last_updated": "2018-07-23",
        "status": "A",
        "authorized_official_last_name": "JERDE",
        "authorized_official_first_name": "ERIC",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "314-962-9334",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "MO",
            "license": "2012018551",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Jerde Eye Specialists",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• All providers in Saint Louis, MO
• Optometrist in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 23, 2018; 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.