Healthcare Provider Details

I. General information

NPI: 1548811391
Provider Name (Legal Business Name): FAMILY EYECARE AND CONTACT LENS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/24/2019
Last Update Date: 06/13/2024
Certification Date: 06/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3325 MAINE STREET SUITE 1
QUINCY IL
62301-4438
US

IV. Provider business mailing address

3325 MAINE ST STE 1
QUINCY IL
62301-4470
US

V. Phone/Fax

Practice location:
  • Phone: 217-231-3937
  • Fax:
Mailing address:
  • Phone: 217-919-2817
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number State

VIII. Authorized Official

Name: KRISTIE N CHEVALIER
Title or Position: OD/OWNER
Credential: OD
Phone: 217-231-3937