=====================================================
General NPI Number Information
=====================================================
NPI Number | 1831980127
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | AFFORDABLE EYECARE LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/15/2025
-----------------------------------------------------
Last Update Date | 05/15/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 815 LINCOLN HWY STE 103
-----------------------------------------------------
City | FAIRVIEW HEIGHTS
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 62208-2230
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 618-628-8868
-----------------------------------------------------
Fax | 618-628-3808
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 815 LINCOLN HWY STE 103
-----------------------------------------------------
City | FAIRVIEW HEIGHTS
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 62208-2230
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 618-628-8868
-----------------------------------------------------
Fax | 618-628-3808
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OPTOMETRIST
-----------------------------------------------------
Name | ALEX MANERA
-----------------------------------------------------
Credential | OD
-----------------------------------------------------
Telephone | 618-628-8868
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------