Provider Demographics
NPI:1033487954
Name:NORTHERN ILLINOIS EYE CLINIC LLC
Entity Type:Organization
Organization Name:NORTHERN ILLINOIS EYE CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:EMILY
Authorized Official - Middle Name:
Authorized Official - Last Name:VELOTTA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-668-5109
Mailing Address - Street 1:333 E IL ROUTE 83
Mailing Address - Street 2:106
Mailing Address - City:MUNDELEIN
Mailing Address - State:IL
Mailing Address - Zip Code:60060-4214
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:333 E IL ROUTE 83
Practice Address - Street 2:106
Practice Address - City:MUNDELEIN
Practice Address - State:IL
Practice Address - Zip Code:60060-4214
Practice Address - Country:US
Practice Address - Phone:847-566-5300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-06
Last Update Date:2021-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty