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General NPI Number Information
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NPI Number | 1790881985
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Entity Type | Organization
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Legal Business Name | VISIONARY EYE CARE PROFESSIONALS PC
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Dates
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Enumeration Date | 09/15/2006
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Last Update Date | 01/26/2017
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Provider Practice Location Address
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Address Line | 181 W MADISON ST SUITE 125
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City | CHICAGO
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State | IL
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Zip | 60602-4510
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Country | US
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Telephone | 312-201-8989
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Fax | 301-201-8984
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Provider Business Mailing Address
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Address Line | 181 W MADISON ST SUITE 125
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City | CHICAGO
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State | IL
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Zip | 60602-4510
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Country | US
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Telephone | 312-201-8989
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Fax | 301-201-8984
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Authorized Official
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Title or Position | CO-OWNER
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Name | DR. MICHAEL CIZSEK
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Credential | OD
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Telephone | 312-201-8989
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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 | 3666-7056
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License Number State | IL
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