Provider Demographics
NPI:1427250422
Name:MIDWEST EYE ASSOCIATES, LLC
Entity type:Organization
Organization Name:MIDWEST EYE ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LANCE
Authorized Official - Middle Name:P
Authorized Official - Last Name:STEAHLY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:217-529-3937
Mailing Address - Street 1:PO BOX 9830
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62791-9830
Mailing Address - Country:US
Mailing Address - Phone:217-529-3937
Mailing Address - Fax:217-529-0968
Practice Address - Street 1:5220 S 6TH STREET RD
Practice Address - Street 2:SUITE 2300
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62703-5735
Practice Address - Country:US
Practice Address - Phone:217-529-3469
Practice Address - Fax:217-529-0968
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-01
Last Update Date:2008-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
No152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
No332H00000XSuppliersEyewear SupplierGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL08432068OtherBCBS GROUP NUMBER
IL205852Medicare PIN
IL08432068OtherBCBS GROUP NUMBER