=====================================================
General NPI Number Information
=====================================================
NPI Number | 1225193931
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | EYE CARE 4 U, S.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/22/2006
-----------------------------------------------------
Last Update Date | 03/07/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1790 NATIONS DR SUITE 214
-----------------------------------------------------
City | GURNEE
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60031-9164
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 847-360-9317
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1790 NATIONS DR SUITE 214
-----------------------------------------------------
City | GURNEE
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60031-9164
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 847-360-9317
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. ROBERT E FISCH
-----------------------------------------------------
Credential | OD
-----------------------------------------------------
Telephone | 847-360-9317
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | 046.005952
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------