Provider Demographics
NPI:1619220258
Name:INFINITY EYECARE LLC
Entity Type:Organization
Organization Name:INFINITY EYECARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:
Authorized Official - Last Name:BRAUER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:217-377-0477
Mailing Address - Street 1:520 N MICHIGAN AVE
Mailing Address - Street 2:#124
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-6982
Mailing Address - Country:US
Mailing Address - Phone:312-595-1171
Mailing Address - Fax:
Practice Address - Street 1:520 N MICHIGAN AVE
Practice Address - Street 2:#124
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-6982
Practice Address - Country:US
Practice Address - Phone:312-595-1171
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-19
Last Update Date:2012-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046010592152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty