Provider Demographics
NPI:1043404346
Name:ADVANCED FAMILY EYECARE CTR. INC
Entity Type:Organization
Organization Name:ADVANCED FAMILY EYECARE CTR. INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTICIAN
Authorized Official - Prefix:MRS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:BRUNDIES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:815-899-2020
Mailing Address - Street 1:920 W PRAIRIE DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:SYCAMORE
Mailing Address - State:IL
Mailing Address - Zip Code:60178-3123
Mailing Address - Country:US
Mailing Address - Phone:815-899-2020
Mailing Address - Fax:815-895-4690
Practice Address - Street 1:920 W PRAIRIE DR
Practice Address - Street 2:SUITE B
Practice Address - City:SYCAMORE
Practice Address - State:IL
Practice Address - Zip Code:60178-3123
Practice Address - Country:US
Practice Address - Phone:815-899-2020
Practice Address - Fax:815-895-4690
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-29
Last Update Date:2007-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier