Provider Demographics
NPI:1417456195
Name:PALOS VISION CARE, INC
Entity Type:Organization
Organization Name:PALOS VISION CARE, INC
Other - Org Name:PALOS VISION CARE, LTD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:L
Authorized Official - Last Name:MONTWILL
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:708-789-0356
Mailing Address - Street 1:11749 SOUTHWEST HWY STE D
Mailing Address - Street 2:
Mailing Address - City:PALOS HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60463-1053
Mailing Address - Country:US
Mailing Address - Phone:708-361-5236
Mailing Address - Fax:708-361-5489
Practice Address - Street 1:11749 SOUTHWEST HWY STE D
Practice Address - Street 2:
Practice Address - City:PALOS HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60463-1053
Practice Address - Country:US
Practice Address - Phone:708-361-5236
Practice Address - Fax:708-361-5489
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-07
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty