Provider Demographics
NPI:1033381405
Name:CARMINE VISION CARE PC
Entity Type:Organization
Organization Name:CARMINE VISION CARE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TERRANCE
Authorized Official - Middle Name:PETER
Authorized Official - Last Name:CARMINE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:708-895-4422
Mailing Address - Street 1:3224 RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:IL
Mailing Address - Zip Code:60438-3129
Mailing Address - Country:US
Mailing Address - Phone:708-895-4422
Mailing Address - Fax:708-895-4482
Practice Address - Street 1:3224 RIDGE RD
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:IL
Practice Address - Zip Code:60438-3129
Practice Address - Country:US
Practice Address - Phone:708-895-4422
Practice Address - Fax:708-895-4482
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-26
Last Update Date:2010-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL46-6715152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0532300001Medicare NSC
ILT36694Medicare UPIN
IL410033967Medicare PIN