Provider Demographics
NPI:1578508263
Name:COMPLETE VISION CARE PC
Entity Type:Organization
Organization Name:COMPLETE VISION CARE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:L
Authorized Official - Last Name:BURY
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:708-423-2500
Mailing Address - Street 1:6209 W 95TH ST
Mailing Address - Street 2:
Mailing Address - City:OAK LAWN
Mailing Address - State:IL
Mailing Address - Zip Code:60453-2701
Mailing Address - Country:US
Mailing Address - Phone:708-423-2845
Mailing Address - Fax:
Practice Address - Street 1:6209 W 95TH ST
Practice Address - Street 2:
Practice Address - City:OAK LAWN
Practice Address - State:IL
Practice Address - Zip Code:60453-2701
Practice Address - Country:US
Practice Address - Phone:708-423-2845
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-18
Last Update Date:2008-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046008858152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILU58957Medicare UPIN
IL1312260001Medicare NSC
IL414550Medicare PIN
ILK44695Medicare UPIN
ILL62755Medicare UPIN