=====================================================
General NPI Number Information
=====================================================
NPI Number | 1770714149
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ENGLISH ROWS EYE CARE, P.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/04/2009
-----------------------------------------------------
Last Update Date | 08/04/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3027 ENGLISH ROW AVE SUITE 209
-----------------------------------------------------
City | NAPERVILLE
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60564-5105
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 620-922-2661
-----------------------------------------------------
Fax | 630-470-6979
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3027 ENGLISH ROW AVE SUITE 209
-----------------------------------------------------
City | NAPERVILLE
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60564-5105
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 620-922-2661
-----------------------------------------------------
Fax | 630-470-6979
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. ALLAN J SMITH
-----------------------------------------------------
Credential | O.D.
-----------------------------------------------------
Telephone | 630-922-2661
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | 046008182
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------