Provider Demographics
NPI:1073002838
Name:LUCEM LLC
Entity Type:Organization
Organization Name:LUCEM LLC
Other - Org Name:WIGHT EYE CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ASHLEY
Authorized Official - Middle Name:A
Authorized Official - Last Name:MEIER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:815-708-7083
Mailing Address - Street 1:6256 E RIVERSIDE BLVD
Mailing Address - Street 2:
Mailing Address - City:LOVES PARK
Mailing Address - State:IL
Mailing Address - Zip Code:61111-4418
Mailing Address - Country:US
Mailing Address - Phone:815-708-7083
Mailing Address - Fax:815-904-6294
Practice Address - Street 1:6256 E RIVERSIDE BLVD
Practice Address - Street 2:
Practice Address - City:LOVES PARK
Practice Address - State:IL
Practice Address - Zip Code:61111-4418
Practice Address - Country:US
Practice Address - Phone:815-708-7083
Practice Address - Fax:815-904-6294
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-08
Last Update Date:2018-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046007443152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty