Provider Demographics
NPI:1447448717
Name:FIRESIDE EYE CARE, P.C.
Entity type:Organization
Organization Name:FIRESIDE EYE CARE, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:
Authorized Official - First Name:SHAWNA
Authorized Official - Middle Name:
Authorized Official - Last Name:HEDDINGHAUS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:217-835-7724
Mailing Address - Street 1:600 S 8TH ST
Mailing Address - Street 2:
Mailing Address - City:BENLD
Mailing Address - State:IL
Mailing Address - Zip Code:62009-1446
Mailing Address - Country:US
Mailing Address - Phone:217-835-7724
Mailing Address - Fax:217-835-7611
Practice Address - Street 1:600 S 8TH ST
Practice Address - Street 2:
Practice Address - City:BENLD
Practice Address - State:IL
Practice Address - Zip Code:62009-1446
Practice Address - Country:US
Practice Address - Phone:217-835-7724
Practice Address - Fax:217-835-7611
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-11
Last Update Date:2025-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL46009181152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0460091814Medicaid
IL05927400OtherBCBS
ILP00184209OtherMEDICARE RR
IL419640OtherHEALTHLINK
IL5275510001OtherADMINASTAR
IL210902OtherMEDICARE GROUP
ILU76517Medicare UPIN
IL0460091814Medicaid
ILP00184209OtherMEDICARE RR