Healthcare Provider Details

I. General information

NPI: 1013049832
Provider Name (Legal Business Name): COMBS EYECARE AND EYEWEAR LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/09/2007
Last Update Date: 06/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

504 HILLGROVE AVE
WESTERN SPRINGS IL
60558-1481
US

IV. Provider business mailing address

504 HILLGROVE AVE
WESTERN SPRINGS IL
60558-1481
US

V. Phone/Fax

Practice location:
  • Phone: 708-286-1100
  • Fax: 708-286-1103
Mailing address:
  • Phone: 708-286-1100
  • Fax: 708-286-1103

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number046008409
License Number StateIL

VIII. Authorized Official

Name: DR. IRENE DOMENICA COMBS
Title or Position: PRESIDENT
Credential: O.D.
Phone: 708-286-1100