Provider Demographics
NPI:1093894081
Name:MARVIN H HEIMLICH,OD
Entity Type:Organization
Organization Name:MARVIN H HEIMLICH,OD
Other - Org Name:BUFFALO GROVE EYE CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARVIN
Authorized Official - Middle Name:HAROLD
Authorized Official - Last Name:HEIMLICH
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:847-541-1184
Mailing Address - Street 1:313 W DUNDEE RD
Mailing Address - Street 2:BUFFALO GROVE EYE CARE CENTER
Mailing Address - City:BUFFALO GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60089-3545
Mailing Address - Country:US
Mailing Address - Phone:847-541-1184
Mailing Address - Fax:847-541-1194
Practice Address - Street 1:313 W DUNDEE RD
Practice Address - Street 2:BUFFALO GROVE EYE CARE CENTER
Practice Address - City:BUFFALO GROVE
Practice Address - State:IL
Practice Address - Zip Code:60089-3545
Practice Address - Country:US
Practice Address - Phone:847-541-1184
Practice Address - Fax:847-541-1194
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-02
Last Update Date:2011-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1618333OtherBLUE CROSS/BLUE SHIELD
IL3405394OtherAETNA
ILIL7448-002OtherEYEMED VISION CARE
IL1618333OtherBLUE CROSS/BLUE SHIELD
IL0499260001Medicare NSC