Provider Demographics
NPI:1558480368
Name:METROPOLITAN EYECARE CENTER OF MANTENO INC
Entity Type:Organization
Organization Name:METROPOLITAN EYECARE CENTER OF MANTENO INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LAURIE
Authorized Official - Middle Name:
Authorized Official - Last Name:COLLETT
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:815-468-2525
Mailing Address - Street 1:170 S LOCUST ST
Mailing Address - Street 2:
Mailing Address - City:MANTENO
Mailing Address - State:IL
Mailing Address - Zip Code:60950-1518
Mailing Address - Country:US
Mailing Address - Phone:815-468-2525
Mailing Address - Fax:815-468-8711
Practice Address - Street 1:170 S LOCUST ST
Practice Address - Street 2:
Practice Address - City:MANTENO
Practice Address - State:IL
Practice Address - Zip Code:60950-1518
Practice Address - Country:US
Practice Address - Phone:815-468-2525
Practice Address - Fax:815-468-8711
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-29
Last Update Date:2013-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty