MEDICARE: DES PLAINES EYECARE CENTER 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	:	1730628033
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DES PLAINES EYECARE CENTER LLC

Provider Business Mailing Address
First Line	:	782 W OAKTON ST
Second Line	:
City	:	DES PLAINES
State	:	IL
Zip	:	60018-1857
Country	:	US
Telephone Number	:	224-236-2020
Fax Number	:	224-236-2021

Provider Business Practice Location Address
First Line	:	782 W OAKTON ST
Second Line	:
City	:	DES PLAINES
State	:	IL
Zip	:	60018-1857
Country	:	US
Telephone Number	:	224-236-2020
Fax Number	:	224-236-2021

Authorized Official
Title or Position	:	OWNER
Name	:	MARINA TODOROVA
Credential	:
Telephone Number	:	224-236-2020

Provider Enumeration Date	:	02/20/2017
Last Update Date	:	05/08/2018

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Directions to “DES PLAINES EYECARE CENTER LLC ” Practice Location

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