Basic Information
| Provider Information | |||||||||
| NPI: | 1174584270 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | GENEVA EYE CLINIC LTD | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | GENEVA OPTICIANS LTD | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1000 RANDALL RD STE 100 | ||||||||
| Address2: | |||||||||
| City: | GENEVA | ||||||||
| State: | IL | ||||||||
| PostalCode: | 601342591 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6302321282 | ||||||||
| FaxNumber: | 6302327011 | ||||||||
| Practice Location | |||||||||
| Address1: | 1000 RANDALL RD STE 100 | ||||||||
| Address2: | |||||||||
| City: | GENEVA | ||||||||
| State: | IL | ||||||||
| PostalCode: | 601342591 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6302321282 | ||||||||
| FaxNumber: | 6302327011 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/29/2006 | ||||||||
| LastUpdateDate: | 01/20/2020 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | HAWKINS | ||||||||
| AuthorizedOfficialFirstName: | ANJALI | ||||||||
| AuthorizedOfficialMiddleName: | S | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 6302321282 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | GENEVA EYE CLINIC, LTD. | ||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | 01/20/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 156FX1800X | N | 193400000X SINGLE SPECIALTY GROUP | Eye and Vision Services Providers | Technician/Technologist | Optician | 332H00000X | Y | Suppliers | Eyewear Supplier (Equipment, not the service) |
No ID Information.