Provider Demographics
NPI:1619279601
Name:VILLAGE EYECARE
Entity Type:Organization
Organization Name:VILLAGE EYECARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PEPSI
Authorized Official - Middle Name:SATPAL
Authorized Official - Last Name:SARAI
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:312-829-6173
Mailing Address - Street 1:1116 W TAYLOR ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60607-4214
Mailing Address - Country:US
Mailing Address - Phone:312-829-6173
Mailing Address - Fax:312-829-3504
Practice Address - Street 1:1116 W TAYLOR ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60607-4214
Practice Address - Country:US
Practice Address - Phone:312-829-6173
Practice Address - Fax:312-829-3504
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:VILLAGE EYE CARE LTD
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-11-23
Last Update Date:2010-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046-009595152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty