MEDICARE: BLACK EYE GROUP, L.L.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	046.010312	IL

General Provider Information

NPI Number	:	1063776292
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BLACK EYE GROUP, L.L.C.

Provider Business Mailing Address
First Line	:	232 S WASHINGTON ST STE 3
Second Line	:
City	:	NAPERVILLE
State	:	IL
Zip	:	60540-5370
Country	:	US
Telephone Number	:	630-369-3937
Fax Number	:

Provider Business Practice Location Address
First Line	:	232 S WASHINGTON ST STE 3
Second Line	:
City	:	NAPERVILLE
State	:	IL
Zip	:	60540-5370
Country	:	US
Telephone Number	:	630-369-3937
Fax Number	:	630-369-3933

Authorized Official
Title or Position	:	OWNER
Name	:	DR. ADAM BLACK
Credential	:	O.D.
Telephone Number	:	630-369-3937

Provider Enumeration Date	:	07/03/2012
Last Update Date	:	10/10/2024

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