Provider Demographics
NPI:1619205077
Name:ELIGIJUS P LELIS MD & ASSOCIATES, SC
Entity Type:Organization
Organization Name:ELIGIJUS P LELIS MD & ASSOCIATES, SC
Other - Org Name:SPECTRUM EYE INSTITUTE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:ELIGIJUS
Authorized Official - Middle Name:P
Authorized Official - Last Name:LELIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:815-725-9377
Mailing Address - Street 1:963 N 129TH INFANTRY DR
Mailing Address - Street 2:STE 110
Mailing Address - City:JOLIET
Mailing Address - State:IL
Mailing Address - Zip Code:60435-3103
Mailing Address - Country:US
Mailing Address - Phone:815-725-9377
Mailing Address - Fax:815-725-9358
Practice Address - Street 1:1870 SILVER CROSS BLVD
Practice Address - Street 2:STE 220
Practice Address - City:NEW LENOX
Practice Address - State:IL
Practice Address - Zip Code:60451-8646
Practice Address - Country:US
Practice Address - Phone:815-725-9377
Practice Address - Fax:815-725-9358
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-24
Last Update Date:2011-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0857370002Medicare NSC