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General NPI Number Information
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NPI Number | 1487958476
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Entity Type | Organization
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Legal Business Name | EYE Q VISION, INC
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Dates
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Enumeration Date | 01/05/2011
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Last Update Date | 04/20/2011
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Provider Practice Location Address
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Address Line | 2127 MIDLANDS CT UNIT 101
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City | SYCAMORE
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State | IL
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Zip | 60178-3173
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Country | US
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Telephone | 815-756-4244
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Fax | 815-756-4244
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Provider Business Mailing Address
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Address Line | 2127 MIDLANDS CT UNIT 101
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City | SYCAMORE
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State | IL
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Zip | 60178-3173
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Country | US
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Telephone | 815-756-4244
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Fax | 815-756-4244
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ANTHONY PETE TSIFTILIS
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Credential | O.D.
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Telephone | 815-756-4244
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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 | 46008933
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License Number State | IL
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