MEDICARE: EYES ON ELBURN LTD LLC

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	046009169	IL

General Provider Information

NPI Number	:	1073767950
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EYES ON ELBURN LTD LLC

Provider Business Mailing Address
First Line	:	135 S MAIN ST
Second Line	:	UNIT 4
City	:	ELBURN
State	:	IL
Zip	:	60119-9108
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	135 S MAIN ST
Second Line	:	UNIT 4
City	:	ELBURN
State	:	IL
Zip	:	60119-9108
Country	:	US
Telephone Number	:	630-365-5225
Fax Number	:	630-365-5240

Authorized Official
Title or Position	:	PRESIDENT
Name	:	KEITH HOUGAS
Credential	:	O.D.
Telephone Number	:	630-365-5225

Provider Enumeration Date	:	11/05/2008
Last Update Date	:	12/06/2012

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Directions to “EYES ON ELBURN LTD LLC ” Practice Location

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