Provider Demographics
NPI:1093722373
Name:MIHEVC, ELIZABETH A (OD)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:A
Last Name:MIHEVC
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 MEMORIAL DR
Mailing Address - Street 2:
Mailing Address - City:CRYSTAL LAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60014-6278
Mailing Address - Country:US
Mailing Address - Phone:815-459-7110
Mailing Address - Fax:815-459-7138
Practice Address - Street 1:300 MEMORIAL DR STE 300
Practice Address - Street 2:
Practice Address - City:CRYSTAL LAKE
Practice Address - State:IL
Practice Address - Zip Code:60014-6273
Practice Address - Country:US
Practice Address - Phone:815-459-7110
Practice Address - Fax:815-459-7138
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2023-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046-008512152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILU36830Medicare UPIN
IL375830Medicare PIN
0978330001Medicare NSC
375830Medicare PIN