Healthcare Provider Details

I. General information

NPI: 1578731246
Provider Name (Legal Business Name): EYECARE CENTER OF DUPAGE, LTD.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/15/2008
Last Update Date: 11/11/2024
Certification Date: 11/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6321 FAIRVIEW AVE STE A
WESTMONT IL
60559-2886
US

IV. Provider business mailing address

6425 DAVANE CT
DOWNERS GROVE IL
60516-3057
US

V. Phone/Fax

Practice location:
  • Phone: 630-852-0102
  • Fax: 630-852-0260
Mailing address:
  • Phone: 630-915-0157
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number046-007544
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number046-007544
License Number StateIL

VIII. Authorized Official

Name: DR. ANTHONY J. PRASNIKAR
Title or Position: PRESIDENT
Credential: O.D.
Phone: 630-915-0157