Provider Demographics
NPI:1396196242
Name:ILLINOIS EYE ASSOCIATES, LTD
Entity Type:Organization
Organization Name:ILLINOIS EYE ASSOCIATES, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:M
Authorized Official - Last Name:PIETRZYK
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:815-478-0100
Mailing Address - Street 1:540 W NORTH ST
Mailing Address - Street 2:SUITE 209
Mailing Address - City:MANHATTAN
Mailing Address - State:IL
Mailing Address - Zip Code:60442-8201
Mailing Address - Country:US
Mailing Address - Phone:815-478-0100
Mailing Address - Fax:815-478-9100
Practice Address - Street 1:116 N SECOND ST
Practice Address - Street 2:
Practice Address - City:PEOTONE
Practice Address - State:IL
Practice Address - Zip Code:60468-9247
Practice Address - Country:US
Practice Address - Phone:708-258-3225
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-22
Last Update Date:2016-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046-009714152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty