Provider Demographics
NPI:1629272521
Name:SPEX EXPRESS INC
Entity Type:Organization
Organization Name:SPEX EXPRESS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:BRIAN
Authorized Official - Last Name:FRANK
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:815-758-1039
Mailing Address - Street 1:2570 DEKALB AVE
Mailing Address - Street 2:
Mailing Address - City:SYCAMORE
Mailing Address - State:IL
Mailing Address - Zip Code:60178-3109
Mailing Address - Country:US
Mailing Address - Phone:815-758-1039
Mailing Address - Fax:815-756-1396
Practice Address - Street 1:2570 DEKALB AVE
Practice Address - Street 2:
Practice Address - City:SYCAMORE
Practice Address - State:IL
Practice Address - Zip Code:60178-3109
Practice Address - Country:US
Practice Address - Phone:815-758-1039
Practice Address - Fax:815-756-1396
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-13
Last Update Date:2010-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046009566152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL046009566Medicaid
ILDP4214Medicare PIN
IL208772Medicare ID - Type Unspecified