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General NPI Number Information
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NPI Number | 1962128090
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Entity Type | Organization
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Legal Business Name | ST MARY EYECARE INC
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Dates
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Enumeration Date | 10/19/2022
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Last Update Date | 10/24/2022
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Provider Practice Location Address
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Address Line | 1700 E RAND RD
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City | ARLINGTON HEIGHTS
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State | IL
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Zip | 60004-4379
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Country | US
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Telephone | 847-463-5354
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Fax |
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Provider Business Mailing Address
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Address Line | 1700 E RAND RD
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City | ARLINGTON HEIGHTS
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State | IL
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Zip | 60004-4379
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OPTOMETRIST
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Name | PETER SILMAN
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Credential | OD
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Telephone | 219-765-7773
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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 |
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License Number State |
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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 |
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License Number State |
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