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General NPI Number Information
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NPI Number | 1932507902
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Entity Type | Organization
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Legal Business Name | EYE CARE CENTER OF LAKE COUNTY, LTD
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Dates
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Enumeration Date | 12/08/2014
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Last Update Date | 12/08/2014
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Provider Practice Location Address
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Address Line | 310 S GREENLEAF ST SUITE 209
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City | GURNEE
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State | IL
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Zip | 60031-5708
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Country | US
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Telephone | 847-244-1657
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Fax | 847-244-5122
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Provider Business Mailing Address
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Address Line | 310 S GREENLEAF ST SUITE 209
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City | GURNEE
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State | IL
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Zip | 60031-5708
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Country | US
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Telephone | 847-244-1657
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Fax | 847-244-5122
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Authorized Official
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Title or Position | OWNER & PRESIDENT OF CORPORATION
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Name | STEVEN D REINGLASS
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Credential | MD
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Telephone | 847-244-1657
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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 | 046009099
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 046009954
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | 036067575
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License Number State | IL
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