Provider Demographics
NPI:1235288564
Name:CLC VISION LLC
Entity Type:Organization
Organization Name:CLC VISION LLC
Other - Org Name:AMERICAN VISION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:COLBY
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:CARTER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:708-442-8899
Mailing Address - Street 1:7317 W 25TH STREET
Mailing Address - Street 2:
Mailing Address - City:NORTH RIVERSIDE
Mailing Address - State:IL
Mailing Address - Zip Code:60546
Mailing Address - Country:US
Mailing Address - Phone:708-442-8899
Mailing Address - Fax:708-442-9466
Practice Address - Street 1:7317 W 25TH STREET
Practice Address - Street 2:
Practice Address - City:NORTH RIVERSIDE
Practice Address - State:IL
Practice Address - Zip Code:60546
Practice Address - Country:US
Practice Address - Phone:708-442-8899
Practice Address - Fax:708-442-9466
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact ManagementGroup - Single Specialty