Provider Demographics
NPI:1497201693
Name:MONICA L CICIMOV & ASSOCIATES INC
Entity Type:Organization
Organization Name:MONICA L CICIMOV & ASSOCIATES INC
Other - Org Name:C&C VISION GALLERY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:MONICA
Authorized Official - Middle Name:L
Authorized Official - Last Name:CICIMOV
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:815-723-2020
Mailing Address - Street 1:179 N CHICAGO ST
Mailing Address - Street 2:
Mailing Address - City:JOLIET
Mailing Address - State:IL
Mailing Address - Zip Code:60432-4126
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:179 N CHICAGO ST
Practice Address - Street 2:
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60432-4126
Practice Address - Country:US
Practice Address - Phone:815-723-2020
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-28
Last Update Date:2016-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty