NPIMap

Organization Active NPI

Mapleshade Vision Center Inc.

  • Optometrist
  • Dunlap, IL
National Provider Identifier
1891820312
Registry record updated Aug 1, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
0460088755 Issued in IL
Legal business name
MAPLESHADE VISION CENTER INC.
Practice address
11825 State Route 40
Suite 101
Dunlap, IL 61525-8842
Phone
(309) 243-5900
Fax
(309) 243-9852
NPI assigned
Feb 23, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 1, 2007

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

Authorized official

Name
Dr. Gaylan Wayne Moushon, O.D.
Title
Owner
Phone
(309) 243-5900

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193400000X SINGLE SPECIALTY GROUP 152W00000X 0460088755 IL Primary

Addresses

Primary practice location

11825 State Route 40
Suite 101
Dunlap, IL 61525-8842

Mailing address

11825 State Route 40
Suite 101
Dunlap, IL 61525-8842
Phone (309) 243-5900

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1172188800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1185926400000",
    "number": "1891820312",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11825 STATE ROUTE 40",
            "address_2": "SUITE 101",
            "city": "DUNLAP",
            "state": "IL",
            "postal_code": "615258842",
            "telephone_number": "309-243-5900",
            "fax_number": "309-243-9852"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11825 STATE ROUTE 40",
            "address_2": "SUITE 101",
            "city": "DUNLAP",
            "state": "IL",
            "postal_code": "615258842",
            "telephone_number": "309-243-5900",
            "fax_number": "309-243-9852"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAPLESHADE VISION CENTER INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-23",
        "last_updated": "2007-08-01",
        "status": "A",
        "authorized_official_last_name": "MOUSHON",
        "authorized_official_first_name": "GAYLAN",
        "authorized_official_middle_name": "WAYNE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "309-243-5900",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "IL",
            "license": "0460088755",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Dunlap, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 1, 2007; 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.