Provider Demographics
NPI:1174959662
Name:FORZLEY-COLANDER EYE CLINIC, INC
Entity type:Organization
Organization Name:FORZLEY-COLANDER EYE CLINIC, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:BRIAN
Authorized Official - Last Name:COLANDER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:773-218-4165
Mailing Address - Street 1:11412 S HARLEM AVE
Mailing Address - Street 2:
Mailing Address - City:WORTH
Mailing Address - State:IL
Mailing Address - Zip Code:60482-2004
Mailing Address - Country:US
Mailing Address - Phone:708-422-7000
Mailing Address - Fax:708-448-4295
Practice Address - Street 1:11412 S HARLEM AVE
Practice Address - Street 2:
Practice Address - City:WORTH
Practice Address - State:IL
Practice Address - Zip Code:60482-2004
Practice Address - Country:US
Practice Address - Phone:708-422-7000
Practice Address - Fax:708-448-4295
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-17
Last Update Date:2013-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046010615152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty