Provider Demographics
NPI:1558850495
Name:JEANIE C. LUCY PC
Entity Type:Organization
Organization Name:JEANIE C. LUCY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JEANIE
Authorized Official - Middle Name:C
Authorized Official - Last Name:LUCY
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:312-860-0654
Mailing Address - Street 1:6340 AMERICANA DRIVE SUITE 1108
Mailing Address - Street 2:
Mailing Address - City:WILLOWBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60527
Mailing Address - Country:US
Mailing Address - Phone:312-860-0654
Mailing Address - Fax:773-346-7252
Practice Address - Street 1:6340 AMERICANA DRIVE SUITE 1108
Practice Address - Street 2:
Practice Address - City:WILLOWBROOK
Practice Address - State:IL
Practice Address - Zip Code:60527
Practice Address - Country:US
Practice Address - Phone:312-860-0654
Practice Address - Fax:773-346-7252
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-07
Last Update Date:2018-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL046008653Medicaid