Provider Demographics
NPI:1659630721
Name:MEDEMAEYECARE&ASSOCIATES PC
Entity Type:Organization
Organization Name:MEDEMAEYECARE&ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:MEDEMA
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:630-881-3339
Mailing Address - Street 1:814 SPRINGFIELD DR
Mailing Address - Street 2:
Mailing Address - City:ROSELLE
Mailing Address - State:IL
Mailing Address - Zip Code:60172-3435
Mailing Address - Country:US
Mailing Address - Phone:630-881-3339
Mailing Address - Fax:847-358-4972
Practice Address - Street 1:814 SPRINGFIELD DR
Practice Address - Street 2:
Practice Address - City:ROSELLE
Practice Address - State:IL
Practice Address - Zip Code:60172-3435
Practice Address - Country:US
Practice Address - Phone:630-881-3339
Practice Address - Fax:847-358-4972
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-10
Last Update Date:2012-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046008031152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty