Provider Demographics
NPI:1497830673
Name:GERIATRIC VISION CARE LLC
Entity Type:Organization
Organization Name:GERIATRIC VISION CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:NOTH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-655-0499
Mailing Address - Street 1:828 NORTH CASS AVENUE
Mailing Address - Street 2:SUITE 1B
Mailing Address - City:WESTMONT
Mailing Address - State:IL
Mailing Address - Zip Code:60559
Mailing Address - Country:US
Mailing Address - Phone:312-829-0956
Mailing Address - Fax:773-904-7855
Practice Address - Street 1:828 NORTH CASS AVE
Practice Address - Street 2:SUITE 1B
Practice Address - City:WESTMONT
Practice Address - State:IL
Practice Address - Zip Code:60559
Practice Address - Country:US
Practice Address - Phone:312-829-0956
Practice Address - Fax:773-904-7855
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-26
Last Update Date:2009-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046009531152W00000X
IL036062589207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
No152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
046009531OtherSTATE OF ILLINOIS PA #
036062589OtherSTATE OF ILLINOIS PA #
IL4798260001Medicare NSC
209715Medicare PIN
046009531OtherSTATE OF ILLINOIS PA #
203478Medicare PIN
203476Medicare PIN
036062589OtherSTATE OF ILLINOIS PA #
U97045Medicare UPIN
C40112Medicare UPIN
209713Medicare PIN
ILCK5546Medicare PIN
209714Medicare PIN