Provider Demographics
NPI:1619255254
Name:VISTA LINDA EYE CARE INC
Entity Type:Organization
Organization Name:VISTA LINDA EYE CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:S
Authorized Official - Last Name:MURRAY
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:847-253-2100
Mailing Address - Street 1:111 W PROSPECT AVE
Mailing Address - Street 2:
Mailing Address - City:MT PROSPECT
Mailing Address - State:IL
Mailing Address - Zip Code:60056-3135
Mailing Address - Country:US
Mailing Address - Phone:847-253-2100
Mailing Address - Fax:847-253-2111
Practice Address - Street 1:111 W PROSPECT AVE
Practice Address - Street 2:
Practice Address - City:MT PROSPECT
Practice Address - State:IL
Practice Address - Zip Code:60056-3135
Practice Address - Country:US
Practice Address - Phone:847-253-2100
Practice Address - Fax:847-253-2111
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-01
Last Update Date:2011-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1851424006Medicaid
ILIL5899Medicare PIN