Provider Demographics
NPI:1578731246
Name:EYECARE CENTER OF DUPAGE, LTD.
Entity Type:Organization
Organization Name:EYECARE CENTER OF DUPAGE, LTD.
Other - Org Name:ANTHONY J. PRASNIKAR O.D., LTD.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:J
Authorized Official - Last Name:PRASNIKAR
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:630-852-0102
Mailing Address - Street 1:6321 FAIRVIEW AVE STE A
Mailing Address - Street 2:
Mailing Address - City:WESTMONT
Mailing Address - State:IL
Mailing Address - Zip Code:60559-2886
Mailing Address - Country:US
Mailing Address - Phone:630-852-0102
Mailing Address - Fax:630-852-0260
Practice Address - Street 1:6321 FAIRVIEW AVE STE A
Practice Address - Street 2:
Practice Address - City:WESTMONT
Practice Address - State:IL
Practice Address - Zip Code:60559-2886
Practice Address - Country:US
Practice Address - Phone:630-852-0102
Practice Address - Fax:630-852-0260
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-15
Last Update Date:2008-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046-007544152W00000X, 332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
No332H00000XSuppliersEyewear SupplierGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0145640001Medicare NSC