Provider Demographics
NPI:1649393323
Name:ADVANCED EYECARE PROFESSIONALS, P.C.
Entity Type:Organization
Organization Name:ADVANCED EYECARE PROFESSIONALS, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:E
Authorized Official - Last Name:PANKOW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-229-2200
Mailing Address - Street 1:10320 S CICERO AVE
Mailing Address - Street 2:
Mailing Address - City:OAK LAWN
Mailing Address - State:IL
Mailing Address - Zip Code:60453-4702
Mailing Address - Country:US
Mailing Address - Phone:708-229-2200
Mailing Address - Fax:708-229-2233
Practice Address - Street 1:10320 S CICERO AVE
Practice Address - Street 2:
Practice Address - City:OAK LAWN
Practice Address - State:IL
Practice Address - Zip Code:60453-4702
Practice Address - Country:US
Practice Address - Phone:708-229-2200
Practice Address - Fax:708-229-2233
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-09
Last Update Date:2017-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01635405OtherBLUECROSS BLUESHIELD
IL206347Medicare ID - Type Unspecified
IL01635405OtherBLUECROSS BLUESHIELD