1306891775 NPI number — DRS. AIDE AND ASSELL OPTOMETRISTS, PC

Table of content: (NPI 1306891775)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306891775 NPI number — DRS. AIDE AND ASSELL OPTOMETRISTS, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DRS. AIDE AND ASSELL OPTOMETRISTS, PC
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:
ILLINOIS EYE CARE CENTERS
Provider Other Organization Name Type Code:
3
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:
1306891775
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2441 W SCHAUMBURG RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SCHAUMBURG
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60194-3886
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
847-301-2727
Provider Business Mailing Address Fax Number:
847-301-0130

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2441 W SCHAUMBURG RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SCHAUMBURG
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60194-3886
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
847-301-2727
Provider Business Practice Location Address Fax Number:
847-301-0130
Provider Enumeration Date:
05/24/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SIMKUS
Authorized Official First Name:
JANICE
Authorized Official Middle Name:
Authorized Official Title or Position:
INSURANCE BILLER
Authorized Official Telephone Number:
847-301-2727

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  152W00000X , 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)

  • Identifier: 046006098 , issued by the state of ( IL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 047-928514 . This is a "DR. AIDE'S TPA & DPA" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 047006098 . This is a "DR. MORGAN TPA & DPA" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".




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