MEDICARE: TC EYECARE, PC

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
1	152W00000X	Optometrist	046008730	IL

General Provider Information

NPI Number	:	1265736078
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TC EYECARE, PC

Provider Business Mailing Address
First Line	:	822 MARION AVE
Second Line	:
City	:	GENEVA
State	:	IL
Zip	:	60134-3246
Country	:	US
Telephone Number	:	239-443-8144
Fax Number	:

Provider Business Practice Location Address
First Line	:	6800 W US HIGHWAY 34
Second Line	:
City	:	PLANO
State	:	IL
Zip	:	60545-9607
Country	:	US
Telephone Number	:	630-552-1593
Fax Number	:	630-552-1595

Authorized Official
Title or Position	:	PRESIDENT
Name	:	TRACY J COWAN
Credential	:	O.D.
Telephone Number	:	239-443-8144

Provider Enumeration Date	:	01/07/2011
Last Update Date	:	01/07/2011

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