Healthcare Provider Details

I. General information

NPI: 1124336524
Provider Name (Legal Business Name): EYES OF CHICAGO, LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2010
Last Update Date: 09/20/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3015 E NEW YORK ST STE A4
AURORA IL
60504-5165
US

IV. Provider business mailing address

3015 E NEW YORK ST STE A4
AURORA IL
60504-5165
US

V. Phone/Fax

Practice location:
  • Phone: 630-851-9669
  • 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 Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MELISSA SALTIJERAL
Title or Position: PRACTICE ADMINISTRATOR
Credential:
Phone: 630-851-9669