Provider Demographics
NPI:1568561447
Name:NAPER GROVE VISION CARE, P.C.
Entity Type:Organization
Organization Name:NAPER GROVE VISION CARE, P.C.
Other - Org Name:NAPER GROVE VISION CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:HALKIAS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:630-357-3511
Mailing Address - Street 1:1331 W 75TH ST STE 403
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60540-9311
Mailing Address - Country:US
Mailing Address - Phone:630-357-3511
Mailing Address - Fax:630-357-0556
Practice Address - Street 1:6840 MAIN ST # 250
Practice Address - Street 2:
Practice Address - City:DOWNERS GROVE
Practice Address - State:IL
Practice Address - Zip Code:60516
Practice Address - Country:US
Practice Address - Phone:630-969-3268
Practice Address - Fax:630-969-3709
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NAPER GROVE VISION CARE, P.C.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-09-21
Last Update Date:2023-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
152W00000X
IL046-010981152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0340590002Medicare NSC
IL208847Medicare PIN