Healthcare Provider Details

I. General information

NPI: 1386941748
Provider Name (Legal Business Name): EYELAND OPTICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/22/2011
Last Update Date: 03/19/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26 E DOWNER PL
AURORA IL
60505-3302
US

IV. Provider business mailing address

26 E DOWNER PL
AURORA IL
60505-3302
US

V. Phone/Fax

Practice location:
  • Phone: 630-892-5000
  • Fax:
Mailing address:
  • Phone: 630-892-5000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code305R00000X
TaxonomyPreferred Provider Organization
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code305S00000X
TaxonomyPoint of Service
License Number
License Number State

VIII. Authorized Official

Name: MR. MARK SALVATORE ARENELLA
Title or Position: OWNER
Credential:
Phone: 630-892-5000