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General NPI Number Information
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NPI Number | 1265596209
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Entity Type | Organization
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Legal Business Name | OPTICA EYE CENTER ASSOCIATES, INC.
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Dates
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Enumeration Date | 12/21/2006
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Last Update Date | 01/22/2016
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Provider Practice Location Address
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Address Line | 366 W ARMY TRAIL RD STE. 310B
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City | BLOOMINGDALE
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State | IL
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Zip | 60108-5601
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Country | US
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Telephone | 630-893-1450
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Fax |
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Provider Business Mailing Address
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Address Line | 366 W ARMY TRAIL RD STE. 310B
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City | BLOOMINGDALE
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State | IL
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Zip | 60108-5601
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Country | US
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Telephone | 630-893-1450
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. CAROL LYNN KOPKE
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Credential | O.D.
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Telephone | 630-893-1450
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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 | 046009159
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License Number State | IL
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