Provider Demographics
NPI:1275662819
Name:BEACON EYE ASSOCIATES PC
Entity Type:Organization
Organization Name:BEACON EYE ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:EVANGELOS
Authorized Official - Middle Name:
Authorized Official - Last Name:VATIANOU
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:630-892-1401
Mailing Address - Street 1:2003 MONTGOMERY RD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60504-9078
Mailing Address - Country:US
Mailing Address - Phone:630-892-1401
Mailing Address - Fax:630-892-1404
Practice Address - Street 1:2003 MONTGOMERY RD
Practice Address - Street 2:SUITE 104
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60504-9078
Practice Address - Country:US
Practice Address - Phone:630-892-1401
Practice Address - Fax:630-892-1404
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-02
Last Update Date:2012-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046009329152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILIL2118Medicare PIN