Provider Demographics
NPI:1366966186
Name:IDEAL EYE SURGERY LLC
Entity type:Organization
Organization Name:IDEAL EYE SURGERY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:VINCENT
Authorized Official - Last Name:STOCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:618-391-1660
Mailing Address - Street 1:705 INSIGHT AVE
Mailing Address - Street 2:
Mailing Address - City:O FALLON
Mailing Address - State:IL
Mailing Address - Zip Code:62269-2146
Mailing Address - Country:US
Mailing Address - Phone:618-391-1660
Mailing Address - Fax:618-861-6003
Practice Address - Street 1:705 INSIGHT AVE
Practice Address - Street 2:
Practice Address - City:O FALLON
Practice Address - State:IL
Practice Address - Zip Code:62269-2146
Practice Address - Country:US
Practice Address - Phone:618-391-1660
Practice Address - Fax:618-861-6003
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-02
Last Update Date:2025-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036.141217207W00000X, 207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty