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General NPI Number Information
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NPI Number | 1497830673
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Entity Type | Organization
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Legal Business Name | GERIATRIC VISION CARE LLC
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Dates
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Enumeration Date | 10/26/2006
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Last Update Date | 10/23/2009
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Provider Practice Location Address
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Address Line | 828 NORTH CASS AVE SUITE 1B
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City | WESTMONT
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State | IL
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Zip | 60559
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Country | US
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Telephone | 312-829-0956
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Fax | 773-904-7855
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Provider Business Mailing Address
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Address Line | 828 NORTH CASS AVENUE SUITE 1B
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City | WESTMONT
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State | IL
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Zip | 60559
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Country | US
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Telephone | 312-829-0956
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Fax | 773-904-7855
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Authorized Official
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Title or Position | SECRETARY TREASURER
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Name | JAMES NOTH
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Credential |
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Telephone | 630-655-0499
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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 | 046009531
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | 036062589
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License Number State | IL
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