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General NPI Number Information
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NPI Number | 1548403041
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Entity Type | Organization
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Legal Business Name | ILLINOIS EYECARE ASSOCIATES, INC
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Dates
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Enumeration Date | 04/13/2009
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Last Update Date | 04/13/2009
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Provider Practice Location Address
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Address Line | 505 W ARMY TRAIL RD
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City | BLOOMINGDALE
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State | IL
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Zip | 60108-1391
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Country | US
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Telephone | 630-802-5192
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Fax |
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Provider Business Mailing Address
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Address Line | 6537 MIDHURST RD
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City | DOWNERS GROVE
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State | IL
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Zip | 60516-2524
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. CHRISTOPHER JOHN STARON
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Credential | O.D.
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Telephone | 630-802-5192
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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 | 046-009202
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License Number State | IL
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