MEDICARE: SARENA EYECARE INC

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	046010314	IL

General Provider Information

NPI Number	:	1700271780
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SARENA EYECARE INC

Provider Business Mailing Address
First Line	:	5809 WASHINGTON ST
Second Line	:
City	:	MORTON GROVE
State	:	IL
Zip	:	60053-3376
Country	:	US
Telephone Number	:	847-867-7051
Fax Number	:

Provider Business Practice Location Address
First Line	:	125 S NORTHWEST HWY
Second Line	:
City	:	PARK RIDGE
State	:	IL
Zip	:	60068-4228
Country	:	US
Telephone Number	:	847-867-7051
Fax Number	:

Authorized Official
Title or Position	:	OPTOMETRIST OWNER
Name	:	LYDIA LIU-TCHORBADJIYSKI
Credential	:
Telephone Number	:	847-867-7051

Provider Enumeration Date	:	04/06/2015
Last Update Date	:	08/26/2015

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Directions to “SARENA EYECARE INC ” Practice Location

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