Provider Demographics
NPI:1407016744
Name:FAMILY EYECARE OF LOCKPORT INC.
Entity Type:Organization
Organization Name:FAMILY EYECARE OF LOCKPORT INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:FRON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:815-836-3937
Mailing Address - Street 1:16612 W 159TH ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:LOCKPORT
Mailing Address - State:IL
Mailing Address - Zip Code:60441-8006
Mailing Address - Country:US
Mailing Address - Phone:815-836-3937
Mailing Address - Fax:815-836-3930
Practice Address - Street 1:16612 W 159TH ST
Practice Address - Street 2:SUITE 200
Practice Address - City:LOCKPORT
Practice Address - State:IL
Practice Address - Zip Code:60441-8006
Practice Address - Country:US
Practice Address - Phone:815-836-3937
Practice Address - Fax:815-836-3930
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-10
Last Update Date:2011-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046008469152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL6461740001Medicare NSC