=====================================================
General NPI Number Information
=====================================================
NPI Number | 1821397472
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HAWTHORN WOODS FAMILY EYE CARE INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/22/2011
-----------------------------------------------------
Last Update Date | 03/22/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 60 LANDOVER PKWY UNIT B1
-----------------------------------------------------
City | HAWTHORN WOODS
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60047-7513
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 773-960-4749
-----------------------------------------------------
Fax | 847-847-2210
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 60 LANDOVER PKWY UNIT B1
-----------------------------------------------------
City | HAWTHORN WOODS
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60047-7513
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 773-960-4749
-----------------------------------------------------
Fax | 847-847-2210
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MRS. AGNIESZKA STRYJECKI
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 773-960-4749
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 156FX1800X
-----------------------------------------------------
Taxonomy Name | Optician
-----------------------------------------------------
License Number | 04900820001
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------