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General NPI Number Information
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NPI Number | 1295074425
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Entity Type | Organization
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Legal Business Name | WINK EYECARE PC
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Dates
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Enumeration Date | 02/07/2013
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Last Update Date | 05/22/2013
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Provider Practice Location Address
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Address Line | 2300 SYCAMORE RD
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City | DEKALB
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State | IL
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Zip | 60115-2067
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Country | US
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Telephone | 815-758-3825
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Fax | 815-758-1214
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Provider Business Mailing Address
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Address Line | 121 DIVISION ST
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City | SAINT CHARLES
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State | IL
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Zip | 60174-4347
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Country | US
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Telephone | 773-220-3900
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Fax |
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Authorized Official
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Title or Position | PRESIDENT/OWNER
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Name | DR. MEGAN MARGARET TWEED
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Credential | O.D.
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Telephone | 773-220-3900
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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 | 046-009432
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License Number State | IL
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