Organization
CENTRAL ILLINOIS OPTOMETRIC ASSOCIATES LTD
Active
Other names
Advanced Eyecare of Carlinville
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KEITH HEDRICK (CEO)
(217) 854-3173
Entity
Organization
Contact information
Practice address
615 N BROAD ST, CARLINVILLE, IL 62626-1020
(217) 854-3173
Mailing address
615 N BROAD ST, CARLINVILLE, IL 62626-1020
(217) 854-3173
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
—
410042452
HEDRICK RAILROAD NUMBER
IL
01
—
410042496
RUBRICH RAILROAD NUMBER
IL
Enumeration date
03/22/2007
Last updated
04/18/2011
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