Healthcare Provider Details

I. General information

NPI: 1891104428
Provider Name (Legal Business Name): ADAS FAMILY EYECARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/07/2014
Last Update Date: 08/07/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2656 N ELSTON AVE
CHICAGO IL
60647-2019
US

IV. Provider business mailing address

2656 N ELSTON AVE
CHICAGO IL
60647-2019
US

V. Phone/Fax

Practice location:
  • Phone: 773-862-0743
  • Fax: 773-862-0893
Mailing address:
  • Phone: 773-862-0743
  • Fax: 773-862-0893

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number046009914
License Number StateIL

VIII. Authorized Official

Name: DR. MAGDALENA ADAS
Title or Position: OPTOMETRIST
Credential: OD
Phone: 847-414-5999