Provider Demographics
NPI:1346338068
Name:ADVANCED FAMILY EYECARE
Entity Type:Organization
Organization Name:ADVANCED FAMILY EYECARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:A
Authorized Official - Last Name:TUEL
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:815-254-2546
Mailing Address - Street 1:15722 S ROUTE 59
Mailing Address - Street 2:BUILDING 140 SUITE B
Mailing Address - City:PLAINFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60544-2795
Mailing Address - Country:US
Mailing Address - Phone:815-254-2546
Mailing Address - Fax:815-254-2566
Practice Address - Street 1:15722 S ROUTE 59
Practice Address - Street 2:BUILDING 140 SUITE B
Practice Address - City:PLAINFIELD
Practice Address - State:IL
Practice Address - Zip Code:60544-2795
Practice Address - Country:US
Practice Address - Phone:815-254-2546
Practice Address - Fax:815-254-2566
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-10
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046-008289152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL9932276OtherBLUE CROSS BLUE SHIELD IL
IL208511Medicare ID - Type Unspecified
ILU41352Medicare UPIN