1902388754 NPI number — EYEMAX INC.

Table of content: (NPI 1902388754)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902388754 NPI number — EYEMAX INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EYEMAX INC.
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:
1902388754
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/07/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2620 HIGH MEADOW RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NAPERVILLE
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60564-4322
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
630-730-3093
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2003 MONTGOMERY RD STE 104
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
AURORA
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60504-9059
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
630-425-8221
Provider Business Practice Location Address Fax Number:
630-425-8222
Provider Enumeration Date:
08/29/2018

Additional Information

Authorized Official

Authorized Official Last Name:
AUNG-KUNIMURA
Authorized Official First Name:
MICHELLE
Authorized Official Middle Name:
K
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
630-425-8221

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  046-009528 , 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: 046009528 , issued by the state of ( IL ) . This identifiers is of the category "MEDICAID".




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