Provider Demographics
NPI:1811088404
Name:INNOVATIVE EYE CARE SOLUTIONS, LTD.
Entity type:Organization
Organization Name:INNOVATIVE EYE CARE SOLUTIONS, LTD.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:VERNON
Authorized Official - Last Name:RITZEL
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:618-233-1270
Mailing Address - Street 1:22 N JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:BELLEVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62220-1425
Mailing Address - Country:US
Mailing Address - Phone:618-233-1270
Mailing Address - Fax:
Practice Address - Street 1:22 N JACKSON ST
Practice Address - Street 2:
Practice Address - City:BELLEVILLE
Practice Address - State:IL
Practice Address - Zip Code:62220-1425
Practice Address - Country:US
Practice Address - Phone:618-233-1270
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-27
Last Update Date:2010-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL6009155152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL211358OtherMEDICARE GROUP
5426840001Medicare NSC
ILU81959Medicare UPIN