MEDICARE: ABBA EYE CARE PC

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	OPT 1000	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1952301129
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ABBA EYE CARE PC

Provider Business Mailing Address
First Line	:	111 E 4TH ST STE 440
Second Line	:
City	:	ALTON
State	:	IL
Zip	:	62002-6206
Country	:	US
Telephone Number	:	618-462-9818
Fax Number	:	314-741-4947

Provider Business Practice Location Address
First Line	:	1130 LAKE PLAZA DR STE 130
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80906-3595
Country	:	US
Telephone Number	:	719-219-3819
Fax Number	:	314-741-4947

Authorized Official
Title or Position	:	OWNER
Name	:	STACY HIEB
Credential	:	OD
Telephone Number	:	618-462-9818

Provider Enumeration Date	:	07/28/2005
Last Update Date	:	09/18/2023

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