| Prairie Eye Center, Ltd | |
|
2020 W Iles Ave, Springfield, IL 62704-4174 | |
| (217) 698-3030 | |
| (217) 698-4728 |
| Full Name | Prairie Eye Center, Ltd |
|---|---|
| Type | Facility |
| Speciality | Ophthalmology |
| Location | 2020 W Iles Ave, Springfield, Illinois |
| Accepts Medicare Assignments | Medicare enrolled and accepts medicare insurance. Providers at this facility may prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1447222864 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 152W00000X | Optometrist | 042-000760 (Illinois) | Secondary |
| 207W00000X | Ophthalmology | (* (Not Available)) | Primary |
| Provider Name | Jennifer M Waller |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1861440612 PECOS PAC ID: 7618955154 Enrollment ID: I20040710000271 |
| Provider Name | Bart A Jones |
|---|---|
| Provider Type | Practitioner - Ophthalmology |
| Provider Identifiers | NPI Number: 1447256797 PECOS PAC ID: 7618944422 Enrollment ID: I20040913000209 |
| Provider Name | Tonya Bourn |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1851340152 PECOS PAC ID: 8527017664 Enrollment ID: I20050117000088 |
| Provider Name | Thucanh Multerer |
|---|---|
| Provider Type | Practitioner - Ophthalmology |
| Provider Identifiers | NPI Number: 1053303362 PECOS PAC ID: 2466483284 Enrollment ID: I20050822000990 |
| Provider Name | Tyson J Herrmann |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1427099951 PECOS PAC ID: 4880605849 Enrollment ID: I20060505000633 |
| Provider Name | Michael P Jones |
|---|---|
| Provider Type | Practitioner - Ophthalmology |
| Provider Identifiers | NPI Number: 1164589164 PECOS PAC ID: 7315047479 Enrollment ID: I20070703000337 |
| Provider Name | Phillip D Alward |
|---|---|
| Provider Type | Practitioner - Ophthalmology |
| Provider Identifiers | NPI Number: 1699735415 PECOS PAC ID: 1759359169 Enrollment ID: I20080304000618 |
| Provider Name | Chelsey M Moore |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1235440777 PECOS PAC ID: 0446384044 Enrollment ID: I20100818000756 |
| Provider Name | Sandra Waiseng Yeh |
|---|---|
| Provider Type | Practitioner - Ophthalmology |
| Provider Identifiers | NPI Number: 1841248838 PECOS PAC ID: 0547173874 Enrollment ID: I20100901000045 |
| Provider Name | Robert James Blumthal |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1578568077 PECOS PAC ID: 4981728706 Enrollment ID: I20100901000084 |
| Provider Name | Ankur Shah |
|---|---|
| Provider Type | Practitioner - Ophthalmology |
| Provider Identifiers | NPI Number: 1851590343 PECOS PAC ID: 6507058120 Enrollment ID: I20101014000074 |
| Provider Name | Brian M Moore |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1033420575 PECOS PAC ID: 9537354956 Enrollment ID: I20101111000523 |
| Provider Name | William Yang |
|---|---|
| Provider Type | Practitioner - Ophthalmology |
| Provider Identifiers | NPI Number: 1790979011 PECOS PAC ID: 9638227614 Enrollment ID: I20110126000598 |
| Provider Name | Elizabeth R Heideman |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1619256013 PECOS PAC ID: 2769653666 Enrollment ID: I20110926000902 |
| Provider Name | Melissa Schleeper Kiel |
|---|---|
| Provider Type | Practitioner - Ophthalmology |
| Provider Identifiers | NPI Number: 1750511242 PECOS PAC ID: 7416196266 Enrollment ID: I20130627000034 |
| Provider Name | Mohamed Gendy |
|---|---|
| Provider Type | Practitioner - Ophthalmology |
| Provider Identifiers | NPI Number: 1508183427 PECOS PAC ID: 7012150139 Enrollment ID: I20150530000158 |
| Provider Name | Monica Ryan |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1003298803 PECOS PAC ID: 8224343553 Enrollment ID: I20150817000812 |
| Provider Name | Emily Marie Beyer |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1063862266 PECOS PAC ID: 3072804020 Enrollment ID: I20160622000198 |
| Provider Name | Nisha Gupta |
|---|---|
| Provider Type | Practitioner - Ophthalmology |
| Provider Identifiers | NPI Number: 1659665263 PECOS PAC ID: 5395985428 Enrollment ID: I20160908000845 |
| Provider Name | Kaylyn Marie Nickelson |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1467930735 PECOS PAC ID: 3779833587 Enrollment ID: I20180829000000 |
| Provider Name | Sara Marie Siebert |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1841778115 PECOS PAC ID: 8325398167 Enrollment ID: I20180829001438 |
| Provider Name | Sean Hendricks |
|---|---|
| Provider Type | Practitioner - Ophthalmology |
| Provider Identifiers | NPI Number: 1164583084 PECOS PAC ID: 2961597018 Enrollment ID: I20180914000789 |
| Provider Name | Alexander R Kane |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1336766377 PECOS PAC ID: 1355765470 Enrollment ID: I20200722002967 |
| Provider Name | Raja Goli |
|---|---|
| Provider Type | Practitioner - Ophthalmology |
| Provider Identifiers | NPI Number: 1598719940 PECOS PAC ID: 2961492863 Enrollment ID: I20211228001841 |
| Provider Name | Alex Willis |
|---|---|
| Provider Type | Practitioner - Ophthalmology |
| Provider Identifiers | NPI Number: 1316442288 PECOS PAC ID: 7214287069 Enrollment ID: I20221027001711 |
| Provider Name | Kenneth D. Farr |
|---|---|
| Provider Type | Practitioner - Ophthalmology |
| Provider Identifiers | NPI Number: 1740366244 PECOS PAC ID: 4688606833 Enrollment ID: I20230303001325 |
| Provider Name | Kaleigh M Albers |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1477252948 PECOS PAC ID: 2365816345 Enrollment ID: I20230314001395 |
| Provider Name | Abdulrahman K Rageh |
|---|---|
| Provider Type | Practitioner - Ophthalmology |
| Provider Identifiers | NPI Number: 1770070146 PECOS PAC ID: 6305240458 Enrollment ID: I20230323001428 |
| Mailing Address | Practice Location Address |
|---|---|
| Prairie Eye Center, Ltd 2020 W Iles Ave, Springfield, IL 62704-4174 Ph: (217) 698-3030 | Prairie Eye Center, Ltd 2020 W Iles Ave, Springfield, IL 62704-4174 Ph: (217) 698-3030 |