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NPI Code Detail

MEDICARE: MYEYEDR OPTOMETRY OF ILLINOIS, LLC

MEDICARE: MYEYEDR OPTOMETRY OF ILLINOIS, 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
1152W00000XOptometrist

General Provider Information

NPI Number : 1912766023
Entity Type Code : Organization
Provider Name (Legal Business Name) : MYEYEDR OPTOMETRY OF ILLINOIS, LLC
Provider Business Mailing Address
First Line : 8614 WESTWOOD CENTER DR FL 9
Second Line :
City : VIENNA
State : VA
Zip : 22182-2442
Country : US
Telephone Number : 703-847-8899
Fax Number : 571-223-6780
Provider Business Practice Location Address
First Line : 732 W ARMY TRAIL RD
Second Line :
City : CAROL STREAM
State : IL
Zip : 60188-9297
Country : US
Telephone Number : 630-372-9501
Fax Number : 630-372-9741
Authorized Official
Title or Position : SECRETARY
Name : SUE DOWNES
Credential :
Telephone Number : 703-847-8899
Provider Enumeration Date : 03/19/2024
Last Update Date : 01/16/2026

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