Provider Demographics
NPI:1114169745
Name:MEYER EYECARE INC
Entity Type:Organization
Organization Name:MEYER EYECARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JILL
Authorized Official - Middle Name:C
Authorized Official - Last Name:INGELSE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:708-388-1228
Mailing Address - Street 1:13114 WESTERN AVE
Mailing Address - Street 2:
Mailing Address - City:BLUE ISLAND
Mailing Address - State:IL
Mailing Address - Zip Code:60406-2439
Mailing Address - Country:US
Mailing Address - Phone:708-388-1228
Mailing Address - Fax:708-388-1696
Practice Address - Street 1:13114 WESTERN AVE
Practice Address - Street 2:
Practice Address - City:BLUE ISLAND
Practice Address - State:IL
Practice Address - Zip Code:60406-2439
Practice Address - Country:US
Practice Address - Phone:708-388-1228
Practice Address - Fax:708-388-1696
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-27
Last Update Date:2023-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046009096152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL046009096Medicaid
IL1634291OtherBLUE CROSS BLUE SHIELD
IL1290690001Medicare NSC
ILDR0185Medicare PIN
IL046009096Medicaid