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General NPI Number Information
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NPI Number | 1861942781
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Entity Type | Organization
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Legal Business Name | EYES ON WHEATON, LLC
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Dates
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Enumeration Date | 10/04/2016
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Last Update Date | 02/09/2017
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Provider Practice Location Address
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Address Line | 127 W WESLEY ST
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City | WHEATON
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State | IL
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Zip | 60187-5118
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Country | US
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Telephone | 605-999-3933
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Fax |
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Provider Business Mailing Address
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Address Line | 127 W WESLEY ST
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City | WHEATON
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State | IL
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Zip | 60187-5118
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Country | US
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Telephone | 605-999-3933
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Fax |
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Authorized Official
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Title or Position | OPTOMETRIST
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Name | DR. CHASE SMITH
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Credential |
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Telephone | 630-923-8410
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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 | 046.010804
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License Number State | IL
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