Provider Demographics
NPI:1235222340
Name:JOHNSON EYE CARE INC
Entity Type:Organization
Organization Name:JOHNSON EYE CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JEANNE
Authorized Official - Middle Name:A
Authorized Official - Last Name:DONAHUE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-516-3111
Mailing Address - Street 1:855 FEINBERG CT
Mailing Address - Street 2:STE 110
Mailing Address - City:CARY
Mailing Address - State:IL
Mailing Address - Zip Code:60013
Mailing Address - Country:US
Mailing Address - Phone:847-516-3111
Mailing Address - Fax:847-516-3133
Practice Address - Street 1:855 FEINBERG CT
Practice Address - Street 2:STE 110
Practice Address - City:CARY
Practice Address - State:IL
Practice Address - Zip Code:60013
Practice Address - Country:US
Practice Address - Phone:847-516-3111
Practice Address - Fax:847-516-3133
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2011-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL046007318Medicaid
IL046009339Medicaid
ILV10313Medicare UPIN
ILU87188Medicare UPIN
ILT38713Medicare UPIN
IL5965080001Medicare NSC
ILL88496Medicare PIN
IL046009339Medicaid
ILL75787Medicare PIN
ILDP9718Medicare PIN