Healthcare Provider Details

I. General information

NPI: 1962516518
Provider Name (Legal Business Name): EYE CARE ASSOCIATES OF NORTHERN ILLINOIS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/19/2006
Last Update Date: 03/01/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3800 HIGHLAND AVE. SUITE 100
DOWNERS GROVE IL
60515
US

IV. Provider business mailing address

3800 HIGHLAND AVE. SUITE 100
DOWNERS GROVE IL
60515
US

V. Phone/Fax

Practice location:
  • Phone: 630-960-0456
  • Fax: 630-963-2116
Mailing address:
  • Phone: 630-960-0456
  • Fax: 630-963-2116

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code152WP0200X
TaxonomyPediatric Optometrist
License Number
License Number StateIL

VIII. Authorized Official

Name: DR. TODD ARTHUR ROBERT
Title or Position: OWNING PARTNER
Credential: O.D.
Phone: 630-960-0456