Provider Demographics
NPI:1629013719
Name:DILLMAN EYE CARE OPTICAL INC
Entity Type:Organization
Organization Name:DILLMAN EYE CARE OPTICAL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:M
Authorized Official - Last Name:DILLMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:217-443-8112
Mailing Address - Street 1:600 NORTH LOGAN AVENUE
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:61832-4375
Mailing Address - Country:US
Mailing Address - Phone:217-443-8112
Mailing Address - Fax:217-443-6779
Practice Address - Street 1:600 NORTH LOGAN AVENUE
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:IL
Practice Address - Zip Code:61832-4375
Practice Address - Country:US
Practice Address - Phone:217-443-8112
Practice Address - Fax:217-443-6779
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-20
Last Update Date:2013-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL3010 9434332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
071762OtherHEALTH ALLIANCE
071762OtherHEALTH ALLIANCE