Provider Demographics
NPI:1376755371
Name:EXCEL EYECARE PROFESSIONALS LLC
Entity Type:Organization
Organization Name:EXCEL EYECARE PROFESSIONALS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LEON
Authorized Official - Middle Name:F
Authorized Official - Last Name:KUBICKI
Authorized Official - Suffix:JR
Authorized Official - Credentials:OD
Authorized Official - Phone:312-493-7993
Mailing Address - Street 1:1133 MCHENRY RD
Mailing Address - Street 2:SUITE 108
Mailing Address - City:BUFFALO GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60089-1369
Mailing Address - Country:US
Mailing Address - Phone:847-478-9091
Mailing Address - Fax:847-478-9095
Practice Address - Street 1:1133 MCHENRY RD
Practice Address - Street 2:SUITE 108
Practice Address - City:BUFFALO GROVE
Practice Address - State:IL
Practice Address - Zip Code:60089-1369
Practice Address - Country:US
Practice Address - Phone:847-478-9091
Practice Address - Fax:847-478-9095
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-04
Last Update Date:2007-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL212589Medicare PIN