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General NPI Number Information
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NPI Number | 1659810802
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Entity Type | Organization
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Legal Business Name | FAMILY EYE CENTERS LLC
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Dates
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Enumeration Date | 02/21/2017
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Last Update Date | 02/21/2017
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Provider Practice Location Address
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Address Line | 22401 CENTRAL AVE
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City | RICHTON PARK
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State | IL
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Zip | 60471-2062
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Country | US
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Telephone | 708-898-9994
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Fax |
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Provider Business Mailing Address
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Address Line | 9336 FALLING WATERS DR W
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City | BURR RIDGE
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State | IL
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Zip | 60527-6889
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Country | US
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Telephone | 773-835-3100
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MOHAMMAD AL-KHUDARI
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Credential | MD
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Telephone | 773-835-3100
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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 |
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License Number State |
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