Provider Demographics
NPI:1548389190
Name:ARQUILLA EYECARE, P.C.
Entity Type:Organization
Organization Name:ARQUILLA EYECARE, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTORPRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:P
Authorized Official - Last Name:ARQUILLA
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:708-798-2030
Mailing Address - Street 1:825 MAPLE AVE
Mailing Address - Street 2:
Mailing Address - City:HOMEWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60430-2031
Mailing Address - Country:US
Mailing Address - Phone:708-798-2030
Mailing Address - Fax:708-798-2080
Practice Address - Street 1:825 MAPLE AVE
Practice Address - Street 2:
Practice Address - City:HOMEWOOD
Practice Address - State:IL
Practice Address - Zip Code:60430-2031
Practice Address - Country:US
Practice Address - Phone:708-798-2030
Practice Address - Fax:708-798-2080
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-28
Last Update Date:2008-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046008539152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1636916OtherBLUE CROSS BLUE SHIELD IL
IL1636916OtherBLUE CROSS BLUE SHIELD IL
IL214860Medicare PIN