Provider Demographics
NPI:1225543481
Name:YORKVILLE VISION LLC
Entity Type:Organization
Organization Name:YORKVILLE VISION LLC
Other - Org Name:YORKVILLE EYE PROFESSIONALS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:PROPATI
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:630-553-5400
Mailing Address - Street 1:620 W VETERANS PKWY STE D
Mailing Address - Street 2:
Mailing Address - City:YORKVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60560-2512
Mailing Address - Country:US
Mailing Address - Phone:630-553-5400
Mailing Address - Fax:
Practice Address - Street 1:620 W VETERANS PKWY STE D
Practice Address - Street 2:
Practice Address - City:YORKVILLE
Practice Address - State:IL
Practice Address - Zip Code:60560-2512
Practice Address - Country:US
Practice Address - Phone:630-553-5400
Practice Address - Fax:630-553-5405
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-11
Last Update Date:2019-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046008553152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL046008553Medicaid