Provider Demographics
NPI:1033290762
Name:VELD VISION CENTER
Entity Type:Organization
Organization Name:VELD VISION CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:VELD
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:708-672-3937
Mailing Address - Street 1:1080 E EXCHANGE ST
Mailing Address - Street 2:
Mailing Address - City:CRETE
Mailing Address - State:IL
Mailing Address - Zip Code:60417-3454
Mailing Address - Country:US
Mailing Address - Phone:708-672-3937
Mailing Address - Fax:708-672-3940
Practice Address - Street 1:1080 E EXCHANGE ST
Practice Address - Street 2:
Practice Address - City:CRETE
Practice Address - State:IL
Practice Address - Zip Code:60417-3454
Practice Address - Country:US
Practice Address - Phone:708-672-3937
Practice Address - Fax:708-672-3940
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-18
Last Update Date:2010-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046008221152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL210093Medicare PIN
ILK11166Medicare ID - Type Unspecified
IL1113970001Medicare NSC
ILT90776Medicare UPIN