Healthcare Provider Details

I. General information

NPI: 1104324938
Provider Name (Legal Business Name): DEKALB EYE CONSULTANTS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/26/2018
Last Update Date: 02/05/2020
Certification Date: 02/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

950 N YORK RD STE 203
HINSDALE IL
60521-8609
US

IV. Provider business mailing address

1630 GATEWAY DR
SYCAMORE IL
60178-3182
US

V. Phone/Fax

Practice location:
  • Phone: 830-789-6700
  • Fax: 630-789-3909
Mailing address:
  • Phone: 815-756-8571
  • Fax: 815-756-5603

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number State

VIII. Authorized Official

Name: GEORGE L NEAL
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 469-214-0144