Healthcare Provider Details

I. General information

NPI: 1952526550
Provider Name (Legal Business Name): EYE CARE CENTER OF LAKE COUNTY, LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/17/2007
Last Update Date: 01/14/2026
Certification Date: 01/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 S GREENLEAF ST STE 212
GURNEE IL
60031-5708
US

IV. Provider business mailing address

310 S GREENLEAF ST STE 212
GURNEE IL
60031-5708
US

V. Phone/Fax

Practice location:
  • Phone: 847-244-1657
  • Fax: 847-244-5122
Mailing address:
  • Phone: 847-244-1657
  • Fax: 847-244-5122

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number046009099
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number046007910
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number036067575
License Number StateIL
# 4
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number036135571
License Number StateIL
# 5
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: ELIZABETH LECLAIR
Title or Position: PRACTICE ADMIN
Credential:
Phone: 847-244-1657