Healthcare Provider Details

I. General information

NPI: 1457686057
Provider Name (Legal Business Name): EYECARE MANAGEMENT, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/15/2009
Last Update Date: 08/10/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

415 W MAIN ST
COLLINSVILLE IL
62234-3043
US

IV. Provider business mailing address

3990 N ILLINOIS ST
SWANSEA IL
62226-1919
US

V. Phone/Fax

Practice location:
  • Phone: 618-345-7887
  • Fax: 618-345-0503
Mailing address:
  • Phone: 618-277-1130
  • Fax: 618-277-4917

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: BART A JONES
Title or Position: OWNER
Credential: MD
Phone: 618-277-1130