Provider Demographics
NPI:1346420072
Name:TOWN EYE CARE OF DOWNERS GROVE INC
Entity Type:Organization
Organization Name:TOWN EYE CARE OF DOWNERS GROVE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CAROLYN
Authorized Official - Middle Name:
Authorized Official - Last Name:DIENES
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:630-627-3001
Mailing Address - Street 1:1412 BUTTERFIELD RD
Mailing Address - Street 2:
Mailing Address - City:DOWNERS GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60515-1031
Mailing Address - Country:US
Mailing Address - Phone:630-627-3001
Mailing Address - Fax:630-627-3021
Practice Address - Street 1:1412 BUTTERFIELD RD
Practice Address - Street 2:
Practice Address - City:DOWNERS GROVE
Practice Address - State:IL
Practice Address - Zip Code:60515-1031
Practice Address - Country:US
Practice Address - Phone:630-627-3001
Practice Address - Fax:630-627-3021
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-09
Last Update Date:2022-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
152W00000X
IL046008922332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
No332H00000XSuppliersEyewear SupplierGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILU79891 ILMedicare UPIN
5134810001Medicare NSC