Provider Demographics
NPI:1073561809
Name:PALATINE VISION CENTER, LLC
Entity Type:Organization
Organization Name:PALATINE VISION CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MORRIS
Authorized Official - Middle Name:S
Authorized Official - Last Name:LEHRFELD, OD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-358-4950
Mailing Address - Street 1:456 W NORTHWEST HWY STE 100
Mailing Address - Street 2:
Mailing Address - City:PALATINE
Mailing Address - State:IL
Mailing Address - Zip Code:60067-2540
Mailing Address - Country:US
Mailing Address - Phone:847-358-4950
Mailing Address - Fax:
Practice Address - Street 1:456 W NORTHWEST HWY STE 100
Practice Address - Street 2:
Practice Address - City:PALATINE
Practice Address - State:IL
Practice Address - Zip Code:60067-2540
Practice Address - Country:US
Practice Address - Phone:847-358-4950
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-04
Last Update Date:2016-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1684559OtherBLUE CROSS BLUE SHIELD
ILT36708Medicare UPIN
ILL92885Medicare ID - Type UnspecifiedDR. ROSANOVA
IL410049158Medicare ID - Type UnspecifiedRAILROAD, DR. ROSANOVA
ILU91367Medicare UPIN
ILL78845Medicare ID - Type UnspecifiedDR. LEHRFELD
IL0437270001Medicare NSC
IL410046375Medicare ID - Type UnspecifiedRAILROAD, DR. LEHRFELD
ILL78844Medicare ID - Type UnspecifiedDR. ERNSTEIN
IL585640Medicare PIN
IL1684559OtherBLUE CROSS BLUE SHIELD
ILU27598Medicare UPIN