Organization
INTERNATIONAL EYECARE CENTER INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CATHY LEE SHORT (CREDENTIALING MANAGER)
(618) 462-9818
Entity
Organization
Contact information
Practice address
1505 W MAIN ST, MT ZION, IL 62549
(217) 864-3221
Mailing address
1505 W MAIN ST, MT ZION, IL 62549-1300
(217) 864-3221
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
—
—
332H00000X
Eyewear Supplier
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1760405047
—
IL
Enumeration date
12/22/2017
Last updated
01/22/2021
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