Healthcare Provider Details

I. General information

NPI: 1801997655
Provider Name (Legal Business Name): DOWNERS GROVE EYE CENTER, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2006
Last Update Date: 04/19/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4958 FOREST AVE
DOWNERS GROVE IL
60515-3508
US

IV. Provider business mailing address

4958 FOREST AVE
DOWNERS GROVE IL
60515-3508
US

V. Phone/Fax

Practice location:
  • Phone: 630-737-1001
  • Fax: 630-737-1003
Mailing address:
  • Phone: 630-737-1001
  • Fax: 630-737-1003

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number046008708
License Number StateIL

VIII. Authorized Official

Name: DR. MICHAEL DONALD MACEK
Title or Position: PRESIDENT
Credential: OD
Phone: 630-737-1001