Provider Demographics
NPI:1104822642
Name:NAPER GROVE VISION CARE, P.C.
Entity Type:Organization
Organization Name:NAPER GROVE VISION CARE, P.C.
Other - Org Name:NAPER GROVE VISION CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:V PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRADLEY
Authorized Official - Middle Name:V
Authorized Official - Last Name:KAMPSCHROEDER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:630-357-3511
Mailing Address - Street 1:1331 W 75TH ST STE 403
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60540-9311
Mailing Address - Country:US
Mailing Address - Phone:630-357-3511
Mailing Address - Fax:
Practice Address - Street 1:1331 W 75TH ST STE 403
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60540-9336
Practice Address - Country:US
Practice Address - Phone:630-357-3511
Practice Address - Fax:630-357-0556
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-21
Last Update Date:2023-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174400000X
IL046-010981174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0340590001Medicare NSC
IL208847Medicare PIN