Provider Demographics
NPI:1548409501
Name:COMPASS EYE CARE, INC.
Entity Type:Organization
Organization Name:COMPASS EYE CARE, INC.
Other - Org Name:COMPASS EYE CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ALBERT
Authorized Official - Middle Name:SIMON
Authorized Official - Last Name:LICUP
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:708-383-2150
Mailing Address - Street 1:603 MADISON ST
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60302-4437
Mailing Address - Country:US
Mailing Address - Phone:708-383-2150
Mailing Address - Fax:708-383-2553
Practice Address - Street 1:603 MADISON ST
Practice Address - Street 2:
Practice Address - City:OAK PARK
Practice Address - State:IL
Practice Address - Zip Code:60302-4437
Practice Address - Country:US
Practice Address - Phone:708-383-2150
Practice Address - Fax:708-383-2553
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-16
Last Update Date:2010-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046.009863152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL6360220001Medicare NSC