Provider Demographics
NPI:1992999890
Name:EYE CARE MANAGEMENT, LLC
Entity type:Organization
Organization Name:EYE CARE MANAGEMENT, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BART
Authorized Official - Middle Name:AARON
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:618-532-1082
Mailing Address - Street 1:3990 N ILLINOIS ST
Mailing Address - Street 2:
Mailing Address - City:SWANSEA
Mailing Address - State:IL
Mailing Address - Zip Code:62226-1919
Mailing Address - Country:US
Mailing Address - Phone:618-277-1130
Mailing Address - Fax:618-277-4917
Practice Address - Street 1:991 FAIRFAX ST
Practice Address - Street 2:
Practice Address - City:CARLYLE
Practice Address - State:IL
Practice Address - Zip Code:62231-1811
Practice Address - Country:US
Practice Address - Phone:618-594-2663
Practice Address - Fax:618-594-1322
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-04
Last Update Date:2014-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036104178152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036104178Medicaid
IL036104178Medicaid
IL4669520005Medicare NSC
IL203195Medicare PIN
IL203194Medicare PIN