Provider Demographics
NPI:1245592369
Name:MILAN MEDICAL JUDGE EYECARE, LLC
Entity Type:Organization
Organization Name:MILAN MEDICAL JUDGE EYECARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ OPTOMETRIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:QUINN
Authorized Official - Middle Name:LINDSAY
Authorized Official - Last Name:JUDGE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:309-787-8100
Mailing Address - Street 1:1929 10TH AVE E
Mailing Address - Street 2:
Mailing Address - City:MILAN
Mailing Address - State:IL
Mailing Address - Zip Code:61264-2953
Mailing Address - Country:US
Mailing Address - Phone:309-787-8100
Mailing Address - Fax:309-787-2643
Practice Address - Street 1:1929 10TH AVE E
Practice Address - Street 2:
Practice Address - City:MILAN
Practice Address - State:IL
Practice Address - Zip Code:61264-2953
Practice Address - Country:US
Practice Address - Phone:309-787-8100
Practice Address - Fax:309-787-2643
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-14
Last Update Date:2012-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046010259152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1205065620OtherNPI