Healthcare Provider Details

I. General information

NPI: 1821029836
Provider Name (Legal Business Name): FAMILY EYE CARE ASSOCIATION, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/06/2006
Last Update Date: 03/16/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

675 SCHOOL ST
HILLSBORO IL
62049-1530
US

IV. Provider business mailing address

675 SCHOOL ST
HILLSBORO IL
62049-1530
US

V. Phone/Fax

Practice location:
  • Phone: 217-532-5044
  • Fax: 217-532-2109
Mailing address:
  • Phone: 217-532-5044
  • Fax: 217-532-2109

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number046008320
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number046007103
License Number StateIL

VIII. Authorized Official

Name: DOUGLAS W. JOHNSON
Title or Position: PRESIDENT
Credential: O.D.
Phone: 217-532-5044