Provider Demographics
NPI:1396212957
Name:EYECARE DIMENSIONS LLC
Entity Type:Organization
Organization Name:EYECARE DIMENSIONS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:PENNER
Authorized Official - Last Name:PENNER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:815-289-6512
Mailing Address - Street 1:134 E BLACKHAWK DR
Mailing Address - Street 2:
Mailing Address - City:BYRON
Mailing Address - State:IL
Mailing Address - Zip Code:61010-8610
Mailing Address - Country:US
Mailing Address - Phone:815-234-2020
Mailing Address - Fax:815-234-7070
Practice Address - Street 1:134 E BLACKHAWK DR
Practice Address - Street 2:
Practice Address - City:BYRON
Practice Address - State:IL
Practice Address - Zip Code:61010-8610
Practice Address - Country:US
Practice Address - Phone:815-234-2020
Practice Address - Fax:815-234-7070
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-31
Last Update Date:2018-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty