MEDICARE: SECOND CITY EYE CARE 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
1	152W00000X	Optometrist

General Provider Information

NPI Number	:	1598289498
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SECOND CITY EYE CARE LLC

Provider Business Mailing Address
First Line	:	4115 N LINCOLN AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60618-3131
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4115 N LINCOLN AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60618-3131
Country	:	US
Telephone Number	:	--
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT/OD
Name	:	DR. ELIZABETH SAXTON-WILLIAMS
Credential	:	OD
Telephone Number	:	773-360-8671

Provider Enumeration Date	:	08/01/2017
Last Update Date	:	01/30/2018

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