Healthcare Provider Details

I. General information

NPI: 1144325358
Provider Name (Legal Business Name): THE EYE CARE CENTER, LTD.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/13/2006
Last Update Date: 02/17/2023
Certification Date: 02/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8525 S HARLEM AVE
BURBANK IL
60459-2293
US

IV. Provider business mailing address

8525 S HARLEM AVE
BURBANK IL
60459-2293
US

V. Phone/Fax

Practice location:
  • Phone: 708-599-0050
  • Fax: 708-599-1099
Mailing address:
  • Phone: 708-599-0050
  • Fax: 708-599-1099

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number046-009852
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number046-009577
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number046006541
License Number StateIL

VIII. Authorized Official

Name: DR. DONNA G. CARVER
Title or Position: ASSOCIATE
Credential: DO
Phone: 708-599-0050