MEDICARE: LAWRENCE 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	046010163	IL

General Provider Information

NPI Number	:	1194952598
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LAWRENCE EYE CARE LLC

Provider Business Mailing Address
First Line	:	3711 W LAWRENCE AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60625-5712
Country	:	US
Telephone Number	:	773-583-5727
Fax Number	:	773-583-7768

Provider Business Practice Location Address
First Line	:	3711 W LAWRENCE AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60625-5712
Country	:	US
Telephone Number	:	773-583-5727
Fax Number	:	773-583-7768

Authorized Official
Title or Position	:	OPTOMETRIST
Name	:	DR. HELLEN YUN
Credential	:	O.D.
Telephone Number	:	847-287-7766

Provider Enumeration Date	:	06/12/2009
Last Update Date	:	10/08/2009

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Directions to “LAWRENCE EYE CARE LLC ” Practice Location

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