MEDICARE: EYECARE MANAGEMENT, LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist		IL

General Provider Information

NPI Number	:	1548276306
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EYECARE MANAGEMENT, LLC

Provider Business Mailing Address
First Line	:	408 W 2ND ST
Second Line	:
City	:	CENTRALIA
State	:	IL
Zip	:	62801-3402
Country	:	US
Telephone Number	:	618-532-5531
Fax Number	:	618-532-6706

Provider Business Practice Location Address
First Line	:	408 W 2ND ST
Second Line	:
City	:	CENTRALIA
State	:	IL
Zip	:	62801-3402
Country	:	US
Telephone Number	:	618-532-5531
Fax Number	:	618-532-6706

Authorized Official
Title or Position	:	CO OWNER
Name	:	BART AARON JONES
Credential	:	M.D.
Telephone Number	:	618-277-1130

Provider Enumeration Date	:	08/01/2006
Last Update Date	:	08/22/2020

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