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NPI Code Detail

MEDICARE: MYEYEDR OPTOMETRY OF ILLINOIS, LLC

MEDICARE: MYEYEDR OPTOMETRY OF ILLINOIS, LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1152W00000XOptometrist

General Provider Information

NPI Number : 1093171613
Entity Type Code : Organization
Provider Name (Legal Business Name) : MYEYEDR OPTOMETRY OF ILLINOIS, LLC
Provider Business Mailing Address
First Line : 8614 WESTWOOD CENTER DR FL 9
Second Line :
City : VIENNA
State : VA
Zip : 22182-2442
Country : US
Telephone Number : 703-847-8899
Fax Number : 571-223-6780
Provider Business Practice Location Address
First Line : 2316 N CLARK ST
Second Line :
City : CHICAGO
State : IL
Zip : 60614-7760
Country : US
Telephone Number : 773-404-0777
Fax Number : 773-404-1725
Authorized Official
Title or Position : SECRETARY
Name : SUE DOWNES
Credential :
Telephone Number : 703-847-8899
Provider Enumeration Date : 01/12/2016
Last Update Date : 05/26/2022

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