Healthcare Provider Details

I. General information

NPI: 1487765251
Provider Name (Legal Business Name): PORRETTA EYECARE, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1410 S RANDALL RD
ALGONQUIN IL
60102-5919
US

IV. Provider business mailing address

620 ECHO TRL
MARENGO IL
60152-8058
US

V. Phone/Fax

Practice location:
  • Phone: 847-458-5796
  • Fax:
Mailing address:
  • Phone: 708-261-4902
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number StateIL

VIII. Authorized Official

Name: THERESE MARIE PORRETTA
Title or Position: PRESIDENT
Credential: O.D.
Phone: 847-458-5796