Provider Demographics
NPI:1093067266
Name:RANJBAR EYECARE CORP
Entity Type:Organization
Organization Name:RANJBAR EYECARE CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AGENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:N
Authorized Official - Last Name:RANJBAR
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:708-547-1893
Mailing Address - Street 1:130 S MANNHEIM RD
Mailing Address - Street 2:
Mailing Address - City:HILLSIDE
Mailing Address - State:IL
Mailing Address - Zip Code:60162-1821
Mailing Address - Country:US
Mailing Address - Phone:708-547-1893
Mailing Address - Fax:408-547-1467
Practice Address - Street 1:130 S MANNHEIM RD
Practice Address - Street 2:
Practice Address - City:HILLSIDE
Practice Address - State:IL
Practice Address - Zip Code:60162-1821
Practice Address - Country:US
Practice Address - Phone:708-547-1893
Practice Address - Fax:408-547-1467
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-11
Last Update Date:2012-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046010356152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty