Organization
CENTRAL ILLINOIS OPTOMETRIC ASSOCIATES LTD
Active
Other names
Advanced Eyecare of Virden
Organization subpart
No
Provider details
NPI number
Authorized official
KEITH HEDRICK (CEO)
(217) 965-3306
Entity
Organization
Contact information
Practice address
119 N SPRINGFIELD ST, VIRDEN, IL 62690-1455
(217) 965-3306
(217) 965-3679
Mailing address
119 N SPRINGFIELD ST, VIRDEN, IL 62690-1455
(217) 965-3306
(217) 965-3679
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
046006408
IL
152W00000X
Optometrist
Primary
046008125
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0001115000
BC BS GROUP NUMBER
IL
05
—
046006408
—
IL
05
—
046008125
—
IL
01
—
410042503
HEDRICK RAILRAOD MEDICARE
IL
01
—
410042688
RUBRICH RAILRAOD MEDICARE
IL
Enumeration date
03/22/2007
Last updated
04/18/2011
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