Provider Demographics
NPI:1588625438
Name:GENEVA EYE CLINIC LTD
Entity Type:Organization
Organization Name:GENEVA EYE CLINIC LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:JOJY
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHLESS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-313-1237
Mailing Address - Street 1:1000 RANDALL RD
Mailing Address - Street 2:STE 100
Mailing Address - City:GENEVA
Mailing Address - State:IL
Mailing Address - Zip Code:60134-2591
Mailing Address - Country:US
Mailing Address - Phone:630-232-1282
Mailing Address - Fax:630-232-7011
Practice Address - Street 1:1000 RANDALL RD
Practice Address - Street 2:STE 100
Practice Address - City:GENEVA
Practice Address - State:IL
Practice Address - Zip Code:60134-2591
Practice Address - Country:US
Practice Address - Phone:630-232-1282
Practice Address - Fax:630-232-7011
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-30
Last Update Date:2021-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
No152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL314740OtherMEDICARE PTAN