MEDICARE: AGELESS EYE CARE P.C.

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	046-009794	IL

General Provider Information

NPI Number	:	1962637439
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AGELESS EYE CARE P.C.

Provider Business Mailing Address
First Line	:	329 W 18TH ST
Second Line	:	#311
City	:	CHICAGO
State	:	IL
Zip	:	60616-1120
Country	:	US
Telephone Number	:	312-929-3340
Fax Number	:

Provider Business Practice Location Address
First Line	:	329 W 18TH ST
Second Line	:	#311
City	:	CHICAGO
State	:	IL
Zip	:	60616-1120
Country	:	US
Telephone Number	:	312-952-4847
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT/OPTOMETRIST
Name	:	DR. LUIS LEWIS
Credential	:	O.D.
Telephone Number	:	312-929-3340

Provider Enumeration Date	:	05/27/2009
Last Update Date	:	09/16/2020

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