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General NPI Number Information
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NPI Number | 1245307636
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Entity Type | Organization
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Legal Business Name | BRENART EYE CLINIC, LLC
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Dates
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Enumeration Date | 11/29/2006
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Last Update Date | 08/11/2010
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Provider Practice Location Address
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Address Line | 120 E COUNTRYSIDE PKWY
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City | YORKVILLE
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State | IL
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Zip | 60560-1877
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Country | US
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Telephone | 630-553-6166
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Fax | 630-553-6178
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Provider Business Mailing Address
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Address Line | 120 E COUNTRYSIDE PKWY
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City | YORKVILLE
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State | IL
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Zip | 60560-1877
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Country | US
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Telephone | 630-553-6166
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Fax | 630-553-6178
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. MARY E MELICK
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Credential | COA, OCS
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Telephone | 630-553-6166
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 046006926
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License Number State | IL
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