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General NPI Number Information
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NPI Number | 1205083383
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Entity Type | Organization
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Legal Business Name | ENVISION EYE CENTER LTD
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Dates
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Enumeration Date | 08/20/2008
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Last Update Date | 12/23/2011
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Provider Practice Location Address
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Address Line | 900 N WESTMORELAND RD SUITE LL84
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City | LAKE FOREST
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State | IL
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Zip | 60045-1681
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Country | US
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Telephone | 847-295-0001
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Fax |
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Provider Business Mailing Address
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Address Line | 900 N WESTMORELAND RD SUITE LL84
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City | LAKE FOREST
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State | IL
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Zip | 60045-1681
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Country | US
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Telephone | 847-295-0001
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | BRADLEY ETHAN RUFF
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Credential | M.D.
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Telephone | 847-295-0001
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | 036062774
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License Number State | IL
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