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General NPI Number Information
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NPI Number | 1265973036
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Entity Type | Organization
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Legal Business Name | BOLINGBROOK EYE CARE & EYEWEAR GALLERY, LLC
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Dates
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Enumeration Date | 03/13/2017
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Last Update Date | 03/13/2017
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Provider Practice Location Address
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Address Line | 124 E BOUGHTON RD
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City | BOLINGBROOK
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State | IL
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Zip | 60440-2014
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Country | US
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Telephone | 630-358-4533
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Fax | 630-348-8133
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Provider Business Mailing Address
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Address Line | 124 E BOUGHTON RD
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City | BOLINGBROOK
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State | IL
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Zip | 60440-2014
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Country | US
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Telephone | 630-358-4533
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Fax | 630-348-8133
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Authorized Official
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Title or Position | OPTOMETRIST
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Name | DR. DAVID VARNEY
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Credential | O.D.
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Telephone | 319-404-7565
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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 | 046010458
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License Number State | IL
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