Provider Demographics
NPI:1467640516
Name:CHITTICK FAMILY VISION CENTER, LTD.
Entity Type:Organization
Organization Name:CHITTICK FAMILY VISION CENTER, LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:AARON
Authorized Official - Middle Name:G
Authorized Official - Last Name:RHOADS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:217-465-6461
Mailing Address - Street 1:112 S MAIN ST # 95
Mailing Address - Street 2:
Mailing Address - City:PARIS
Mailing Address - State:IL
Mailing Address - Zip Code:61944-1731
Mailing Address - Country:US
Mailing Address - Phone:217-465-6461
Mailing Address - Fax:217-465-6461
Practice Address - Street 1:112 S MAIN ST # 95
Practice Address - Street 2:
Practice Address - City:PARIS
Practice Address - State:IL
Practice Address - Zip Code:61944-1731
Practice Address - Country:US
Practice Address - Phone:217-465-6461
Practice Address - Fax:217-465-6461
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-12
Last Update Date:2008-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL282350OtherMEDICARE GROUP NUMBER
IL0211930001Medicare NSC