Provider Demographics
NPI:1518181304
Name:EYE CARE CENTER OF LAKE COUNTY REFRACTIVE SURGERY ASSOCIATES
Entity Type:Organization
Organization Name:EYE CARE CENTER OF LAKE COUNTY REFRACTIVE SURGERY ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JANICE
Authorized Official - Middle Name:
Authorized Official - Last Name:MERKT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-244-1657
Mailing Address - Street 1:2424 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:WAUKEGAN
Mailing Address - State:IL
Mailing Address - Zip Code:60085-5074
Mailing Address - Country:US
Mailing Address - Phone:847-244-1657
Mailing Address - Fax:847-244-5122
Practice Address - Street 1:6 E PHILLIP RD
Practice Address - Street 2:SUITE 1110
Practice Address - City:VERNON HILLS
Practice Address - State:IL
Practice Address - Zip Code:60061-1700
Practice Address - Country:US
Practice Address - Phone:847-244-1657
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL04915265OtherBLUE CROSS - BLUE SHIELD