MEDICARE: BRIGHT EYES FAMILY VISION, INC

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	046010411	IL

General Provider Information

NPI Number	:	1649647967
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRIGHT EYES FAMILY VISION, INC

Provider Business Mailing Address
First Line	:	2401 W US HIGHWAY 20
Second Line	:	UNIT 107
City	:	PINGREE GROVE
State	:	IL
Zip	:	60140-8818
Country	:	US
Telephone Number	:	224-569-1001
Fax Number	:	847-423-6090

Provider Business Practice Location Address
First Line	:	2401 W US HIGHWAY 20
Second Line	:	UNIT 107
City	:	PINGREE GROVE
State	:	IL
Zip	:	60140-8818
Country	:	US
Telephone Number	:	224-569-1001
Fax Number	:	847-423-6090

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. KARA PULSFUS
Credential	:	O.D.
Telephone Number	:	224-569-1001

Provider Enumeration Date	:	08/24/2015
Last Update Date	:	01/04/2017

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Directions to “BRIGHT EYES FAMILY VISION, INC ” Practice Location

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