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General NPI Number Information
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NPI Number | 1851827273
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Entity Type | Organization
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Legal Business Name | ICARE4VISION LLC
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Dates
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Enumeration Date | 05/04/2017
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Last Update Date | 05/10/2017
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Provider Practice Location Address
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Address Line | 1231 BUTTERFIELD RD
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City | WHEATON
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State | IL
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Zip | 60189-8809
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Country | US
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Telephone | 630-665-6560
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Fax | 630-665-8760
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Provider Business Mailing Address
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Address Line | 1231 BUTTERFIELD RD
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City | WHEATON
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State | IL
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Zip | 60189-8809
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Country | US
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Telephone | 630-665-6560
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Fax | 630-665-8760
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Authorized Official
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Title or Position | SOLE MEMBER
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Name | NATALIE T CEPYNSKY
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Credential | OD
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Telephone | 630-665-6560
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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 | 046007880
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License Number State | IL
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