Healthcare Provider Details

I. General information

NPI: 1902156896
Provider Name (Legal Business Name): ARTISTIC EYE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/18/2012
Last Update Date: 06/09/2025
Certification Date: 06/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6800 S. MAIN STREET SUITE LL-5
DOWNERS GROVE IL
60516-3593
US

IV. Provider business mailing address

573 CAMBRIDGE WAY
BOLINGBROOK IL
60440-1047
US

V. Phone/Fax

Practice location:
  • Phone: 630-985-5008
  • Fax: 630-981-0458
Mailing address:
  • Phone: 630-914-4144
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1700X
TaxonomyOcularist
License Number0631512
License Number StateIL

VIII. Authorized Official

Name: BEVERLY WOLTMAN
Title or Position: MANAGER/OWNER
Credential: BCO
Phone: 630-914-4144