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General NPI Number Information
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NPI Number | 1306314794
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Entity Type | Organization
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Legal Business Name | ELITE EYE CARE, LLC
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Dates
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Enumeration Date | 11/05/2018
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Last Update Date | 12/03/2018
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Provider Practice Location Address
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Address Line | 555 S DEARBORN ST
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City | CHICAGO
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State | IL
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Zip | 60605-1586
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Country | US
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Telephone | 312-614-2020
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Fax | 312-626-5139
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Provider Business Mailing Address
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Address Line | 5438 S 74TH AVE
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City | SUMMIT
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State | IL
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Zip | 60501-1013
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Country | US
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Telephone | 312-614-2020
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Fax |
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Authorized Official
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Title or Position | SOLE OWNER
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Name | DR. MATTHEW DANIEL PIETRUSZKA
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Credential | OD
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Telephone | 708-256-5135
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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 |
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License Number State |
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