Healthcare Provider Details

I. General information

NPI: 1437714342
Provider Name (Legal Business Name): FREEDOM VISION CENTERS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/06/2019
Last Update Date: 05/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13327 S ROUTE 59 UNIT 111
PLAINFIELD IL
60585-5897
US

IV. Provider business mailing address

2777 FINLEY RD STE 13
DOWNERS GROVE IL
60515-1012
US

V. Phone/Fax

Practice location:
  • Phone: 708-859-8000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: VICK MEHTA
Title or Position: MANAGING PARTNER
Credential:
Phone: 630-850-0500