Provider Demographics
NPI:1104926674
Name:GREENVILLE EYEGLASS & CONTACTS INC
Entity type:Organization
Organization Name:GREENVILLE EYEGLASS & CONTACTS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:LILE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:618-664-9101
Mailing Address - Street 1:216 N THIRD ST
Mailing Address - Street 2:STE B
Mailing Address - City:GREENVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62246-1004
Mailing Address - Country:US
Mailing Address - Phone:618-664-9101
Mailing Address - Fax:618-664-9657
Practice Address - Street 1:216 N THIRD ST
Practice Address - Street 2:STE B
Practice Address - City:GREENVILLE
Practice Address - State:IL
Practice Address - Zip Code:62246-1004
Practice Address - Country:US
Practice Address - Phone:618-664-9101
Practice Address - Fax:618-664-9657
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-25
Last Update Date:2008-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1235122466Medicaid
IL1265504443Medicaid
IL1104926674OtherNPI
IL1104926674OtherNPI
IL1235122466Medicaid
ILK34730Medicare PIN
IL212551Medicare PIN
IL5015840001Medicare NSC