Provider Demographics
NPI:1477766699
Name:BARTLETT VISION CENTER PC
Entity Type:Organization
Organization Name:BARTLETT VISION CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT AND PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:KRISTINA
Authorized Official - Middle Name:
Authorized Official - Last Name:GABRENYA
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:630-837-9500
Mailing Address - Street 1:211 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BARTLETT
Mailing Address - State:IL
Mailing Address - Zip Code:60103-4456
Mailing Address - Country:US
Mailing Address - Phone:630-837-9500
Mailing Address - Fax:630-837-9517
Practice Address - Street 1:211 S MAIN ST
Practice Address - Street 2:
Practice Address - City:BARTLETT
Practice Address - State:IL
Practice Address - Zip Code:60103-4456
Practice Address - Country:US
Practice Address - Phone:630-837-9500
Practice Address - Fax:630-837-9517
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-07
Last Update Date:2020-08-22
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
IL212593Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER