1619205077 NPI number — ELIGIJUS P LELIS MD & ASSOCIATES, SC

Table of content: (NPI 1255603619)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619205077 NPI number — ELIGIJUS P LELIS MD & ASSOCIATES, SC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ELIGIJUS P LELIS MD & ASSOCIATES, SC
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:
SPECTRUM EYE INSTITUTE
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:
1619205077
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/04/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
963 N 129TH INFANTRY DR
Provider Second Line Business Mailing Address:
STE 110
Provider Business Mailing Address City Name:
JOLIET
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60435-3103
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
815-725-9377
Provider Business Mailing Address Fax Number:
815-725-9358

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1870 SILVER CROSS BLVD
Provider Second Line Business Practice Location Address:
STE 220
Provider Business Practice Location Address City Name:
NEW LENOX
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60451-8646
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
815-725-9377
Provider Business Practice Location Address Fax Number:
815-725-9358
Provider Enumeration Date:
11/24/2009

Additional Information

Authorized Official

Authorized Official Last Name:
LELIS
Authorized Official First Name:
ELIGIJUS
Authorized Official Middle Name:
P
Authorized Official Title or Position:
OWNER/CEO
Authorized Official Telephone Number:
815-725-9377

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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