Provider Demographics
NPI:1003137829
Name:EXCELLENT EYE CARE INC.
Entity Type:Organization
Organization Name:EXCELLENT EYE CARE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROMUALD
Authorized Official - Middle Name:
Authorized Official - Last Name:KUZA
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:773-777-7444
Mailing Address - Street 1:5352 N MILWAUKEE AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60630-1250
Mailing Address - Country:US
Mailing Address - Phone:773-777-7444
Mailing Address - Fax:773-775-4030
Practice Address - Street 1:5352 N MILWAUKEE AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60630-1250
Practice Address - Country:US
Practice Address - Phone:773-777-7444
Practice Address - Fax:773-775-4030
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-15
Last Update Date:2010-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046009902261Q00000X, 261QP2300X, 261QS0132X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No261QS0132XAmbulatory Health Care FacilitiesClinic/CenterOphthalmologic Surgery