MEDICARE: EASY OPTICAL EYE CARE 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	046009691	IL

General Provider Information

NPI Number	:	1811392517
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EASY OPTICAL EYE CARE INC.

Provider Business Mailing Address
First Line	:	3457 W 111TH ST.
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60655
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3457 W 111TH ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60655-3335
Country	:	US
Telephone Number	:	773-253-2175
Fax Number	:

Authorized Official
Title or Position	:	ADMIN
Name	:	VYTAUTAS TAMULIS
Credential	:
Telephone Number	:	815-483-9504

Provider Enumeration Date	:	10/24/2014
Last Update Date	:	10/24/2014

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