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General NPI Number Information
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NPI Number | 1922513928
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Entity Type | Organization
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Legal Business Name | SPRINGDALE EYECARE LLC
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Dates
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Enumeration Date | 12/12/2017
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Last Update Date | 12/12/2017
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Provider Practice Location Address
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Address Line | 5450 WOLF RD
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City | WESTERN SPRINGS
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State | IL
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Zip | 60558-1852
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Country | US
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Telephone | 708-820-2020
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Fax |
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Provider Business Mailing Address
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Address Line | 10701 CHERRYWOOD DR
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City | PALOS PARK
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State | IL
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Zip | 60464-3701
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Country | US
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Telephone | 312-912-1812
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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. TANYA HALIKIAS
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Credential | OD
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Telephone | 312-912-1812
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 46009983
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License Number State | IL
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