Provider Demographics
NPI:1003133471
Name:METROPOLITAN EYECARE CENTER OF PARK FOREST
Entity Type:Organization
Organization Name:METROPOLITAN EYECARE CENTER OF PARK FOREST
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:COLLETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-748-6016
Mailing Address - Street 1:3406 VOLLMER RD
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA FIELDS
Mailing Address - State:IL
Mailing Address - Zip Code:60461-1018
Mailing Address - Country:US
Mailing Address - Phone:708-748-6016
Mailing Address - Fax:708-748-6079
Practice Address - Street 1:3406 VOLLMER RD
Practice Address - Street 2:
Practice Address - City:OLYMPIA FIELDS
Practice Address - State:IL
Practice Address - Zip Code:60461-1018
Practice Address - Country:US
Practice Address - Phone:708-748-6016
Practice Address - Fax:708-748-6079
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-26
Last Update Date:2010-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty