Provider Demographics
NPI:1083722730
Name:EYECARE PARTNERS, LLC
Entity Type:Organization
Organization Name:EYECARE PARTNERS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:M
Authorized Official - Last Name:BRTVA
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:217-875-2622
Mailing Address - Street 1:1135 HICKORY POINT MALL
Mailing Address - Street 2:
Mailing Address - City:FORSYTH
Mailing Address - State:IL
Mailing Address - Zip Code:62535-2014
Mailing Address - Country:US
Mailing Address - Phone:217-875-2622
Mailing Address - Fax:217-875-2639
Practice Address - Street 1:1135 HICKORY POINT MALL
Practice Address - Street 2:
Practice Address - City:FORSYTH
Practice Address - State:IL
Practice Address - Zip Code:62535-2014
Practice Address - Country:US
Practice Address - Phone:217-875-2622
Practice Address - Fax:217-875-2639
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-25
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========TOtherBLUE CROSS BLUE SHIELD
ILDE8069Medicare ID - Type UnspecifiedRAILROAD MEDICARE
IL=========TOtherBLUE CROSS BLUE SHIELD