MEDICARE: DEKALB EYE CONSULTANTS, 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	207W00000X	Ophthalmology Physician
2	152W00000X	Optometrist

General Provider Information

NPI Number	:	1689180572
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DEKALB EYE CONSULTANTS, LLC

Provider Business Mailing Address
First Line	:	1630 GATEWAY DR
Second Line	:
City	:	SYCAMORE
State	:	IL
Zip	:	60178-3182
Country	:	US
Telephone Number	:	815-756-8571
Fax Number	:	815-756-5603

Provider Business Practice Location Address
First Line	:	1794 S ARLINGTON HEIGHTS RD
Second Line	:
City	:	ARLINGTON HEIGHTS
State	:	IL
Zip	:	60005-3727
Country	:	US
Telephone Number	:	847-640-1211
Fax Number	:	847-640-1218

Authorized Official
Title or Position	:	CHIEF EXECUTIVE OFFICER
Name	:	GEORGE L NEAL
Credential	:
Telephone Number	:	469-214-0144

Provider Enumeration Date	:	12/14/2017
Last Update Date	:	02/05/2020

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