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General NPI Number Information
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NPI Number | 1073765467
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Entity Type | Organization
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Legal Business Name | FUTURE VISION LASER CENTER
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Dates
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Enumeration Date | 10/16/2008
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Last Update Date | 10/04/2011
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Provider Practice Location Address
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Address Line | 477 E BUTTERFIELD RD SUITE 101
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City | LOMBARD
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State | IL
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Zip | 60148-5618
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Country | US
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Telephone | 630-724-1400
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Fax | 630-724-1410
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Provider Business Mailing Address
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Address Line | 477 E BUTTERFIELD RD SUITE 101
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City | LOMBARD
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State | IL
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Zip | 60148-5618
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Country | US
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Telephone | 630-724-1400
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Fax | 630-724-1410
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Authorized Official
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Title or Position | OPHTHALMOLOGIST
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Name | DR. RICHARD B. FOULKES
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Credential | M.D.
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Telephone | 630-724-1400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | 036-086926
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License Number State | IL
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