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General NPI Number Information
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NPI Number | 1528559846
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Entity Type | Organization
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Legal Business Name | SERPICO FAMILY EYE CARE, INC.
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Dates
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Enumeration Date | 05/22/2018
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Last Update Date | 05/22/2018
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Provider Practice Location Address
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Address Line | 6 E PHILLIP RD STE 1110
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City | VERNON HILLS
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State | IL
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Zip | 60061-1700
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Country | US
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Telephone | 847-816-9996
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Fax | 847-816-3142
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Provider Business Mailing Address
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Address Line | 6 E PHILLIP RD STE 1110
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City | VERNON HILLS
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State | IL
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Zip | 60061-1700
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Country | US
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Telephone | 847-816-9996
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Fax | 847-816-3142
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Authorized Official
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Title or Position | OPTOMETRIST AND OWNER
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Name | DR. ANTHONY A SERPICO
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Credential | OD
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Telephone | 847-924-6452
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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 | 046-009099
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License Number State | IL
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