Provider Demographics
NPI:1013404755
Name:JENCY ELAKKATT, S.C.
Entity Type:Organization
Organization Name:JENCY ELAKKATT, S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST/ PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JENCY
Authorized Official - Middle Name:
Authorized Official - Last Name:ELAKKATT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:312-318-4626
Mailing Address - Street 1:926 W STONEHEDGE DR
Mailing Address - Street 2:
Mailing Address - City:ADDISON
Mailing Address - State:IL
Mailing Address - Zip Code:60101-3159
Mailing Address - Country:US
Mailing Address - Phone:312-318-4626
Mailing Address - Fax:
Practice Address - Street 1:1460 GOLF RD
Practice Address - Street 2:
Practice Address - City:ROLLING MEADOWS
Practice Address - State:IL
Practice Address - Zip Code:60008-4206
Practice Address - Country:US
Practice Address - Phone:847-734-0450
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-18
Last Update Date:2018-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046-009421152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty