Organization
DECATUR EYECARE ASSOCIATES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CHARLES E BEDFORD OD (OPTOMETRIST/OWNER)
(217) 422-8032
Entity
Organization
Contact information
Practice address
1270 S JASPER ST, DECATUR, IL 62521-3531
(217) 422-8032
Mailing address
1270 S JASPER ST, DECATUR, IL 62521-3531
(217) 422-8032
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
467080
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0005884011
BLUE CROSS AND SHIELD OF ILLINOIS
IL
05
—
046007080
—
IL
01
—
4095740001
DMERC MEDICARE
IL
01
—
410017583
RAILROAD MEDICARE
IL
01
—
714680
MEDICARE ID
IL
Enumeration date
06/19/2008
Last updated
06/19/2008
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