Provider Demographics
NPI:1508889866
Name:VON HOLTEN EYECARE, LTD.
Entity Type:Organization
Organization Name:VON HOLTEN EYECARE, LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:VON HOLTEN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:815-922-3545
Mailing Address - Street 1:24541 S BLACKHAWK DR
Mailing Address - Street 2:
Mailing Address - City:CHANNAHON
Mailing Address - State:IL
Mailing Address - Zip Code:60410-9303
Mailing Address - Country:US
Mailing Address - Phone:815-922-3545
Mailing Address - Fax:
Practice Address - Street 1:25824 W EAMES ST
Practice Address - Street 2:
Practice Address - City:CHANNAHON
Practice Address - State:IL
Practice Address - Zip Code:60410-5313
Practice Address - Country:US
Practice Address - Phone:815-521-9950
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-26
Last Update Date:2013-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046009558152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL213926OtherPTAN