MEDICARE: VEP IL OPTOMETRIC LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist

General Provider Information

NPI Number	:	1740843622
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VEP IL OPTOMETRIC LLC

Provider Business Mailing Address
First Line	:	PO BOX 800148
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64180-0148
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	525 W TOWN CENTER BLVD
Second Line	:
City	:	CHAMPAIGN
State	:	IL
Zip	:	61822-1248
Country	:	US
Telephone Number	:	217-531-5393
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	ERIC BIRKY
Credential	:
Telephone Number	:	309-663-2700

Provider Enumeration Date	:	04/17/2019
Last Update Date	:	07/29/2024

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Directions to “VEP IL OPTOMETRIC LLC ” Practice Location

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