Provider Demographics
NPI:1386004224
Name:ARTISAN EYECARE, LLC
Entity Type:Organization
Organization Name:ARTISAN EYECARE, LLC
Other - Org Name:ARTISAN EYECARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:CHRISTOPHER
Authorized Official - Last Name:WOOLDRIDGE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:773-906-5725
Mailing Address - Street 1:3929 N WESTERN AVE
Mailing Address - Street 2:STORE SOUTH
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60618-3759
Mailing Address - Country:US
Mailing Address - Phone:773-906-5725
Mailing Address - Fax:773-906-5724
Practice Address - Street 1:3929 N WESTERN AVE
Practice Address - Street 2:STORE SOUTH
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60618-3759
Practice Address - Country:US
Practice Address - Phone:773-906-5725
Practice Address - Fax:773-906-5724
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-04
Last Update Date:2016-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty