Provider Demographics
NPI:1326494295
Name:BLINK FAMILY EYE CARE LLC
Entity Type:Organization
Organization Name:BLINK FAMILY EYE CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST/OWNER/MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:NGA
Authorized Official - Middle Name:N
Authorized Official - Last Name:PHAN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:847-877-8077
Mailing Address - Street 1:1650 W BELMONT AVE
Mailing Address - Street 2:1E
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-3018
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1650 W BELMONT AVE
Practice Address - Street 2:1E
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-3018
Practice Address - Country:US
Practice Address - Phone:847-877-8077
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-10
Last Update Date:2016-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046.010008152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty