MEDICARE: LAKEVIEW EYECARE CENTER LTD

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	046.008449	IL

General Provider Information

NPI Number	:	1871692863
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LAKEVIEW EYECARE CENTER LTD

Provider Business Mailing Address
First Line	:	3500 N ASHLAND AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60657-1314
Country	:	US
Telephone Number	:	773-327-0874
Fax Number	:	773-327-6535

Provider Business Practice Location Address
First Line	:	3500 N ASHLAND AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60657-1314
Country	:	US
Telephone Number	:	773-327-0874
Fax Number	:	773-327-6535

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. ALAN DAVID WEILER
Credential	:	OD
Telephone Number	:	773-327-0874

Provider Enumeration Date	:	09/22/2006
Last Update Date	:	12/04/2008

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