Provider Demographics
NPI:1639410830
Name:BELMONT EYECARE LLC
Entity Type:Organization
Organization Name:BELMONT EYECARE LLC
Other - Org Name:BELMONT EYE CARE
Other - Org Type:Other Name
Authorized Official - Title/Position:DOCTOR OF OPTOMETRY
Authorized Official - Prefix:DR
Authorized Official - First Name:GOLIE
Authorized Official - Middle Name:ROSHANDEL
Authorized Official - Last Name:KEOVAN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:312-217-9563
Mailing Address - Street 1:3110 W BELMONT AVE
Mailing Address - Street 2:UNIT 1E
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60618-5788
Mailing Address - Country:US
Mailing Address - Phone:312-217-9563
Mailing Address - Fax:312-626-2398
Practice Address - Street 1:3110 W BELMONT AVE
Practice Address - Street 2:UNIT 1E
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60618-5788
Practice Address - Country:US
Practice Address - Phone:312-217-9563
Practice Address - Fax:312-488-2643
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-13
Last Update Date:2015-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty