Healthcare Provider Details

I. General information

NPI: 1386121283
Provider Name (Legal Business Name): AEA EYE CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/24/2018
Last Update Date: 05/19/2026
Certification Date: 05/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4814 N CLARK ST STE B
CHICAGO IL
60640-7767
US

IV. Provider business mailing address

4814 N CLARK ST STE B
CHICAGO IL
60640-7767
US

V. Phone/Fax

Practice location:
  • Phone: 773-897-0800
  • Fax: 773-897-0457
Mailing address:
  • Phone: 773-897-0800
  • Fax: 773-897-0457

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number StateIL

VIII. Authorized Official

Name: ANDREW LADOCHI
Title or Position: OWNER
Credential:
Phone: 773-897-0800