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General NPI Number Information
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NPI Number | 1902156896
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Entity Type | Organization
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Legal Business Name | ARTISTIC EYE, LLC
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Dates
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Enumeration Date | 09/18/2012
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Last Update Date | 06/09/2025
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Provider Practice Location Address
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Address Line | 6800 S. MAIN STREET SUITE LL-5
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City | DOWNERS GROVE
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State | IL
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Zip | 60516-3593
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Country | US
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Telephone | 630-985-5008
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Fax | 630-981-0458
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Provider Business Mailing Address
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Address Line | 573 CAMBRIDGE WAY
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City | BOLINGBROOK
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State | IL
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Zip | 60440-1047
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Country | US
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Telephone | 630-914-4144
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Fax |
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Authorized Official
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Title or Position | MANAGER/OWNER
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Name | BEVERLY WOLTMAN
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Credential | BCO
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Telephone | 630-914-4144
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 156FX1700X
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Taxonomy Name | Ocularist
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License Number | 0631512
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License Number State | IL
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