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General NPI Number Information
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NPI Number | 1265736078
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Entity Type | Organization
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Legal Business Name | TC EYECARE, PC
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Dates
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Enumeration Date | 01/07/2011
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Last Update Date | 01/07/2011
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Provider Practice Location Address
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Address Line | 6800 W US HIGHWAY 34
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City | PLANO
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State | IL
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Zip | 60545-9607
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Country | US
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Telephone | 630-552-1593
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Fax | 630-552-1595
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Provider Business Mailing Address
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Address Line | 822 MARION AVE
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City | GENEVA
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State | IL
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Zip | 60134-3246
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Country | US
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Telephone | 239-443-8144
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | TRACY J COWAN
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Credential | O.D.
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Telephone | 239-443-8144
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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 | 046008730
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License Number State | IL
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