Organization
OPTOMETRIC EYECARE, INC
Active
Parent organization
OPTOMETRIC EYECARE, INC
Other names
Mt. Carmel EyeCare
Organization subpart
Yes
Provider details
NPI number
Legal business name
OPTOMETRIC EYECARE, INC
Authorized official
DR. CLARK E DESHON O.D. (PRESIDENT)
(618) 263-3362
Entity
Organization
Contact information
Practice address
715 CHESTNUT ST, MOUNT CARMEL, IL 62863-1454
(618) 263-3362
(618) 263-6001
Mailing address
715 CHESTNUT ST, MOUNT CARMEL, IL 62863-1454
(618) 263-3362
(618) 263-6001
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
046-008793
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
046008793
—
IL
01
—
09327152
BLUE CROSS BLUE SHIELD OF IL
IL
01
—
1861482309
PALMETTO GBA - RAILROAD MEDICARE
—
01
—
5290131
AETNA
IL
Enumeration date
02/27/2009
Last updated
03/09/2010
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