Provider Demographics
NPI:1568505816
Name:DOYLE OPTICIANS OF DEERFIELD, INC
Entity Type:Organization
Organization Name:DOYLE OPTICIANS OF DEERFIELD, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTICIAN
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SCOTT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-498-3737
Mailing Address - Street 1:405 LAKE COOK RD
Mailing Address - Street 2:SUITE A-12
Mailing Address - City:DEERFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60015-4993
Mailing Address - Country:US
Mailing Address - Phone:847-498-3737
Mailing Address - Fax:
Practice Address - Street 1:405 LAKE COOK RD
Practice Address - Street 2:SUITE A-12
Practice Address - City:DEERFIELD
Practice Address - State:IL
Practice Address - Zip Code:60015-4993
Practice Address - Country:US
Practice Address - Phone:847-498-3737
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-15
Last Update Date:2012-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0324580001Medicare NSC