Provider Demographics
NPI:1659810802
Name:FAMILY EYE CENTERS LLC
Entity Type:Organization
Organization Name:FAMILY EYE CENTERS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MOHAMMAD
Authorized Official - Middle Name:
Authorized Official - Last Name:AL-KHUDARI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:773-835-3100
Mailing Address - Street 1:9336 FALLING WATERS DR W
Mailing Address - Street 2:
Mailing Address - City:BURR RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60527-6889
Mailing Address - Country:US
Mailing Address - Phone:773-835-3100
Mailing Address - Fax:
Practice Address - Street 1:22401 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:RICHTON PARK
Practice Address - State:IL
Practice Address - Zip Code:60471-2062
Practice Address - Country:US
Practice Address - Phone:708-898-9994
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-21
Last Update Date:2017-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty