MEDICARE: E&G EYE CARE PLLC

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	:	1760048995
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	E&G EYE CARE PLLC

Provider Business Mailing Address
First Line	:	2951 N TALMAN AVE APT 3F
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60618-7837
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	8362 GRAND AVE
Second Line	:
City	:	RIVER GROVE
State	:	IL
Zip	:	60171-1435
Country	:	US
Telephone Number	:	847-409-2158
Fax Number	:

Authorized Official
Title or Position	:	OWNER/OPTOMETRIST
Name	:	DR. EVA SHABO
Credential	:	OD
Telephone Number	:	847-409-2158

Provider Enumeration Date	:	05/13/2019
Last Update Date	:	05/13/2019

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