Healthcare Provider Details

I. General information

NPI: 1952809782
Provider Name (Legal Business Name): DEKALB EYE CONSULTANTS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/26/2018
Last Update Date: 02/05/2020
Certification Date: 02/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3711 W LAWRENCE AVE
CHICAGO IL
60625-5712
US

IV. Provider business mailing address

1630 GATEWAY DR
SYCAMORE IL
60178-3182
US

V. Phone/Fax

Practice location:
  • Phone: 773-583-5727
  • Fax: 773-583-7768
Mailing address:
  • Phone: 815-756-8571
  • Fax: 815-756-5603

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: GEORGE L NEAL
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 469-214-0144