1861766651 NPI number — LOOK EYE CARE AND EYE WEAR, LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861766651 NPI number — LOOK EYE CARE AND EYE WEAR, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LOOK EYE CARE AND EYE WEAR, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1861766651
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/07/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1048 104TH ST
Provider Second Line Business Mailing Address:
SUITE 100
Provider Business Mailing Address City Name:
NAPERVILLE
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60564-5118
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
630-360-2393
Provider Business Mailing Address Fax Number:
630-560-4919

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1048 104TH ST
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
NAPERVILLE
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60564-5118
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
630-360-2393
Provider Business Practice Location Address Fax Number:
630-560-4919
Provider Enumeration Date:
02/27/2012

Additional Information

Authorized Official

Authorized Official Last Name:
GOODWIN
Authorized Official First Name:
ROBERT
Authorized Official Middle Name:
D
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
630-360-2393

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  IL046010211 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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