Basic Information
| Provider Information | |||||||||
| NPI: | 1497959795 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | FAMILY EYE CARE OF BOLINGBROOK LTD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 310 S WEBER RD | ||||||||
| Address2: | |||||||||
| City: | BOLINGBROOK | ||||||||
| State: | IL | ||||||||
| PostalCode: | 604905500 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6307710600 | ||||||||
| FaxNumber: | 6307599692 | ||||||||
| Practice Location | |||||||||
| Address1: | 310 S WEBER RD | ||||||||
| Address2: | |||||||||
| City: | BOLINGBROOK | ||||||||
| State: | IL | ||||||||
| PostalCode: | 604905500 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6307710600 | ||||||||
| FaxNumber: | 6307599692 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/12/2007 | ||||||||
| LastUpdateDate: | 04/06/2017 | ||||||||
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| AuthorizedOfficialLastName: | FRANKEL | ||||||||
| AuthorizedOfficialFirstName: | HAL | ||||||||
| AuthorizedOfficialMiddleName: | SCOTT | ||||||||
| AuthorizedOfficialTitleorPosition: | OPTOMETRIST | ||||||||
| AuthorizedOfficialTelephone: | 6307710600 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | O.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152WX0102X | 046008325 | IL | Y | 193400000X SINGLE SPECIALTY GROUP | Eye and Vision Services Providers | Optometrist | Occupational Vision |
No ID Information.