Provider Demographics
NPI:1427231760
Name:ADVANCED EYECARE GROUP PC
Entity Type:Organization
Organization Name:ADVANCED EYECARE GROUP PC
Other - Org Name:DRS. JESSEN WESLEY AND ASSOC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:E
Authorized Official - Last Name:O'HAGAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-848-3900
Mailing Address - Street 1:3335 N ARLINGTON HEIGHTS RD STE M
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60004-1573
Mailing Address - Country:US
Mailing Address - Phone:847-398-0800
Mailing Address - Fax:
Practice Address - Street 1:3335 N ARLINGTON HEIGHTS RD STE M
Practice Address - Street 2:
Practice Address - City:ARLINGTON HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60004-1573
Practice Address - Country:US
Practice Address - Phone:847-398-0800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-10
Last Update Date:2008-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0001616047OtherBLUE CROSS BLUE SHIELD
IL0001616047OtherBLUE CROSS BLUE SHIELD