Healthcare Provider Details

I. General information

NPI: 1235222340
Provider Name (Legal Business Name): JOHNSON EYE CARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 03/31/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

855 FEINBERG CT STE 110
CARY IL
60013
US

IV. Provider business mailing address

855 FEINBERG CT STE 110
CARY IL
60013
US

V. Phone/Fax

Practice location:
  • Phone: 847-516-3111
  • Fax: 847-516-3133
Mailing address:
  • Phone: 847-516-3111
  • Fax: 847-516-3133

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MRS. JEANNE A DONAHUE
Title or Position: OFFICE MANAGER
Credential:
Phone: 847-516-3111