Central Illinois Family Eyecare LLC

Primary specialty

OptometristTaxonomy code 152W00000X

License

046-007731 Issued in IL

Legal business name

CENTRAL ILLINOIS FAMILY EYECARE LLC

Doing business as

Bloomington Eye Professionals

Practice address

1015 S Mercer Ave
Bloomington, IL 61701-7107

Phone

(309) 213-9200

Fax

(309) 213-9300

NPI assigned

Mar 10, 2017

Last updated

Feb 28, 2022By the provider in NPPES

Organization subpart

Yes

Parent organization

CENTRAL ILLINOIS FAMILY EYECARE LLCAs reported in NPPES

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

Authorized official

Name

Dr. Dennis M Brtva, ODNPI 1215909056

Title

Owner

Phone

(309) 213-9200

Specialties & licenses 1

Addresses

Other names 1

• Bloomington Eye Professionals Doing business as

Medicare fee-for-service enrollment

Enrolled in IL

Enrollment records 1

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

• Central Illinois Family Eyecare LLC

  dba Peoria Eye Professionals

  • Optometrist
  • Peoria, IL
  • NPI 1053852020

  O20170327000707

  Same enrollment

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Tax ID family

Central Illinois Family Eyecare LLC2 organizations share this tax ID, including this one

Part of

Central Illinois Family Eyecare LLC

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Central Illinois Family Eyecare LLC

  dba Peoria Eye Professionals

  • Optometrist
  • Peoria, IL
  • NPI 1053852020
  NPD tax ID

Locations

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

• Central Illinois Family Eyecare LLC

  dba Peoria Eye Professionals

  • Optometrist
  • Peoria, IL
  • NPI 1053852020
  NPPES parent name

Practitioners 2

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.

• Dennis M Brtva, O.D.

  • Optometrist
  • Bloomington, IL
  • NPI 1215909056
  Medicare reassignment Care Compare group Authorized official
• Ashley Foster, OD

  • Optometrist
  • Bloomington, IL
  • NPI 1396399374
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1489104000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1646006400000",
    "number": "1881135853",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1015 S MERCER AVE",
            "city": "BLOOMINGTON",
            "state": "IL",
            "postal_code": "617017107",
            "telephone_number": "309-213-9200",
            "fax_number": "309-213-9300"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1015 S MERCER AVE",
            "city": "BLOOMINGTON",
            "state": "IL",
            "postal_code": "617017107",
            "telephone_number": "309-213-9200",
            "fax_number": "309-213-9300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CENTRAL ILLINOIS FAMILY EYECARE LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "CENTRAL ILLINOIS FAMILY EYECARE LLC",
        "enumeration_date": "2017-03-10",
        "last_updated": "2022-02-28",
        "certification_date": "2022-02-28",
        "status": "A",
        "authorized_official_last_name": "BRTVA",
        "authorized_official_first_name": "DENNIS",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "309-213-9200",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "IL",
            "license": "046-007731",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Bloomington Eye Professionals",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Bloomington Eye Professionals",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Optometrist in Bloomington, IL
• Providers in Bloomington, IL by specialty
• Optometrist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 28, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.