Provider Demographics
NPI:1730628033
Name:DES PLAINES EYECARE CENTER LLC
Entity type:Organization
Organization Name:DES PLAINES EYECARE CENTER LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARINA
Authorized Official - Middle Name:
Authorized Official - Last Name:TODOROVA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:224-236-2020
Mailing Address - Street 1:782 W OAKTON ST
Mailing Address - Street 2:
Mailing Address - City:DES PLAINES
Mailing Address - State:IL
Mailing Address - Zip Code:60018-1857
Mailing Address - Country:US
Mailing Address - Phone:224-236-2020
Mailing Address - Fax:224-236-2021
Practice Address - Street 1:782 W OAKTON ST
Practice Address - Street 2:
Practice Address - City:DES PLAINES
Practice Address - State:IL
Practice Address - Zip Code:60018-1857
Practice Address - Country:US
Practice Address - Phone:224-236-2020
Practice Address - Fax:224-236-2021
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-20
Last Update Date:2018-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty