Healthcare Provider Details

I. General information

NPI: 1962128090
Provider Name (Legal Business Name): ST MARY EYECARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/19/2022
Last Update Date: 10/24/2022
Certification Date: 10/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 E RAND RD
ARLINGTON HEIGHTS IL
60004-4379
US

IV. Provider business mailing address

1700 E RAND RD
ARLINGTON HEIGHTS IL
60004-4379
US

V. Phone/Fax

Practice location:
  • Phone: 847-463-5354
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: PETER SILMAN
Title or Position: OPTOMETRIST
Credential: OD
Phone: 219-765-7773