Healthcare Provider Details

I. General information

NPI: 1124348917
Provider Name (Legal Business Name): SEVEN BRIDGES EYE CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/03/2010
Last Update Date: 04/01/2021
Certification Date: 04/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6440 MAIN ST SUITE 100
WOODRIDGE IL
60517-1752
US

IV. Provider business mailing address

6440 MAIN ST SUITE 100
WOODRIDGE IL
60517-1752
US

V. Phone/Fax

Practice location:
  • Phone: 630-824-0101
  • Fax: 630-824-0105
Mailing address:
  • Phone: 630-824-0101
  • Fax: 630-824-0105

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number046007886
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number
License Number State

VIII. Authorized Official

Name: JUAN PRADO
Title or Position: OFFICE MANAGER
Credential:
Phone: 630-232-7800