=====================================================
General NPI Number Information
=====================================================
NPI Number | 1770967044
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PS EYECARE INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/16/2015
-----------------------------------------------------
Last Update Date | 07/16/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7000 MANNHEIM RD
-----------------------------------------------------
City | ROSEMONT
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60018-3621
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 847-768-5601
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7000 MANNHEIM RD
-----------------------------------------------------
City | ROSEMONT
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60018-3621
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OPTOMETRIST
-----------------------------------------------------
Name | DR. PREET SAJNANI
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 630-362-7192
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | 046010467
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------