Basic Information
| Provider Information | |||||||||
| NPI: | 1194084350 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | EYE HEALTH SOLUTIONS LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1066 MCKNIGHT CIR | ||||||||
| Address2: | APT 2 | ||||||||
| City: | ROCKFORD | ||||||||
| State: | IL | ||||||||
| PostalCode: | 611076403 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8152662036 | ||||||||
| FaxNumber: | 8152662058 | ||||||||
| Practice Location | |||||||||
| Address1: | 2545 IL ROUTE 26 S | ||||||||
| Address2: | |||||||||
| City: | FREEPORT | ||||||||
| State: | IL | ||||||||
| PostalCode: | 610329370 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8152662036 | ||||||||
| FaxNumber: | 8152662058 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/09/2012 | ||||||||
| LastUpdateDate: | 05/09/2012 | ||||||||
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| AuthorizedOfficialLastName: | PARRETT | ||||||||
| AuthorizedOfficialFirstName: | BRIAN | ||||||||
| AuthorizedOfficialMiddleName: | W | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT / OWNER | ||||||||
| AuthorizedOfficialTelephone: | 8152662036 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | OD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | 046-010186 | IL | Y | 193400000X SINGLE SPECIALTY GROUP | Eye and Vision Services Providers | Optometrist |
ID Information
| ID | Type | State | Issuer | Description | 046-010186 | 01 | IL | OD LICENSE | OTHER |