Provider Demographics
NPI:1174584270
Name:GENEVA EYE CLINIC LTD
Entity type:Organization
Organization Name:GENEVA EYE CLINIC LTD
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANJALI
Authorized Official - Middle Name:S
Authorized Official - Last Name:HAWKINS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:630-232-1282
Mailing Address - Street 1:1000 RANDALL RD STE 100
Mailing Address - Street 2:
Mailing Address - City:GENEVA
Mailing Address - State:IL
Mailing Address - Zip Code:60134-2591
Mailing Address - Country:US
Mailing Address - Phone:630-232-1282
Mailing Address - Fax:630-232-7011
Practice Address - Street 1:1000 RANDALL RD STE 100
Practice Address - Street 2:
Practice Address - City:GENEVA
Practice Address - State:IL
Practice Address - Zip Code:60134-2591
Practice Address - Country:US
Practice Address - Phone:630-232-1282
Practice Address - Fax:630-232-7011
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GENEVA EYE CLINIC, LTD.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-03-29
Last Update Date:2020-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332H00000XSuppliersEyewear Supplier
No156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0244590001Medicare NSC