=====================================================
General NPI Number Information
=====================================================
NPI Number | 1649307737
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | EYE CARE CENTER OF LAKE COUNTY, LTD
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/27/2007
-----------------------------------------------------
Last Update Date | 01/14/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 310 S GREENLEAF ST STE 212
-----------------------------------------------------
City | GURNEE
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60031-5708
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 847-244-1657
-----------------------------------------------------
Fax | 847-244-1522
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 310 S GREENLEAF ST STE 212
-----------------------------------------------------
City | GURNEE
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60031-5708
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 847-244-1657
-----------------------------------------------------
Fax | 847-244-5122
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRACTICE ADMIN
-----------------------------------------------------
Name | ELIZABETH LECLAIR
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 847-244-1657
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207W00000X
-----------------------------------------------------
Taxonomy Name | Ophthalmology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------