MEDICARE: MIDWEST EYE ASSOCIATES, LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	152W00000X	Optometrist
2	332H00000X	Eyewear Supplier
3	207W00000X	Ophthalmology Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	08432068	OTHER	IL	BCBS GROUP NUMBER

General Provider Information

NPI Number	:	1427250422
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MIDWEST EYE ASSOCIATES, LLC

Provider Business Mailing Address
First Line	:	PO BOX 9830
Second Line	:
City	:	SPRINGFIELD
State	:	IL
Zip	:	62791-9830
Country	:	US
Telephone Number	:	217-529-3937
Fax Number	:	217-529-0968

Provider Business Practice Location Address
First Line	:	5220 S 6TH STREET RD
Second Line	:	SUITE 2300
City	:	SPRINGFIELD
State	:	IL
Zip	:	62703-5735
Country	:	US
Telephone Number	:	217-529-3469
Fax Number	:	217-529-0968

Authorized Official
Title or Position	:	OWNER
Name	:	DR. LANCE P STEAHLY
Credential	:	MD
Telephone Number	:	217-529-3937

Provider Enumeration Date	:	06/01/2007
Last Update Date	:	02/28/2008

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Directions to “MIDWEST EYE ASSOCIATES, LLC ” Practice Location

Language	Start Address	Practice Location

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