MEDICARE: BUSH FAMILY EYE CARE, 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

General Provider Information

NPI Number	:	1104247519
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BUSH FAMILY EYE CARE, LLC

Provider Business Mailing Address
First Line	:	10434 S KEDZIE AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60655-2018
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	10434 S KEDZIE AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60655-2018
Country	:	US
Telephone Number	:	773-445-2700
Fax Number	:

Authorized Official
Title or Position	:	OPTOMETRIST
Name	:	EILEEN BUSH
Credential	:	OD
Telephone Number	:	773-445-2700

Provider Enumeration Date	:	01/02/2014
Last Update Date	:	01/02/2014

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