Provider Demographics
NPI:1437386687
Name:BELLEN EYECARE, LTD
Entity Type:Organization
Organization Name:BELLEN EYECARE, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:P
Authorized Official - Last Name:BELLEN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:847-722-5314
Mailing Address - Street 1:519 W MELROSE ST APT 412
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-3785
Mailing Address - Country:US
Mailing Address - Phone:847-722-5314
Mailing Address - Fax:847-972-3013
Practice Address - Street 1:3752 W 16TH ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60623-2028
Practice Address - Country:US
Practice Address - Phone:773-522-3220
Practice Address - Fax:847-972-3013
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-15
Last Update Date:2009-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046009768152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty