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General NPI Number Information
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NPI Number | 1881727741
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Entity Type | Organization
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Legal Business Name | EYE PHYSICIANS OF KANKAKEE,LTD
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Dates
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Enumeration Date | 03/13/2007
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Last Update Date | 12/13/2011
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Provider Practice Location Address
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Address Line | 372 LARRY POWER RD SUITE1
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City | BOURBONNAIS
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State | IL
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Zip | 60914-5190
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Country | US
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Telephone | 815-933-5202
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Fax | 815-933-6531
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Provider Business Mailing Address
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Address Line | 372 LARRY POWER RD SUITE1
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City | BOURBONNAIS
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State | IL
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Zip | 60914-5190
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Country | US
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Telephone | 815-933-5202
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Fax | 815-933-6531
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Authorized Official
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Title or Position | OPHTHALMOLOGIST
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Name | DR. STEVEN J BURNS
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Credential | MD
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Telephone | 815-933-5202
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number | 036103938
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License Number State | IL
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