International Eyecare Center Inc

Primary specialty

OptometristTaxonomy code 152W00000X

Legal business name

INTERNATIONAL EYECARE CENTER INC

Practice address

1505 W Main St
Mt Zion, IL 62549

Phone

(217) 864-3221

NPI assigned

Dec 22, 2017

Last updated

Jan 22, 2021By 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

Cathy Lee Short

Title

Credentialing Manager

Phone

(618) 462-9818

Specialties & licenses 2

Addresses

Other identifiers 1

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

{
    "created_epoch": "1513900800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1611273600000",
    "number": "1831605096",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1505 W MAIN ST",
            "city": "MT ZION",
            "state": "IL",
            "postal_code": "625491300",
            "telephone_number": "217-864-3221"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1505 W MAIN ST",
            "city": "MT ZION",
            "state": "IL",
            "postal_code": "62549",
            "telephone_number": "217-864-3221"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INTERNATIONAL EYECARE CENTER INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-12-22",
        "last_updated": "2021-01-22",
        "certification_date": "2021-01-22",
        "status": "A",
        "authorized_official_last_name": "SHORT",
        "authorized_official_first_name": "CATHY",
        "authorized_official_middle_name": "LEE",
        "authorized_official_title_or_position": "CREDENTIALING MANAGER",
        "authorized_official_telephone_number": "618-462-9818"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "332H00000X",
            "taxonomy_group": "",
            "desc": "Eyewear Supplier",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1760405047",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Shawn Hendershot, PTA
• Jessica M Hentrich
• Heritage Manor - Mt. Zion, L.L.C. (Heritage Health)
• Heritage Manor - Mt. Zion, LLC (Heritage Health - Mt. Zion)
• Morgan Nicole Holst, MS CCC-SLP
• Jac Stores Inc (Sav Mor Pharmacy)
• Carly Morgan Johnson, R.D.
• Kevin Douglas Johnston, DC
• Brittany Keck-Flory, DMD
• Katelyn Keller, APRN

• Optometrist in Mt Zion, IL
• Providers in Mt Zion, IL by specialty
• Optometrist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 22, 2021; 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.