Provider Demographics
NPI:1679823132
Name:EYEDOCTORS PC
Entity Type:Organization
Organization Name:EYEDOCTORS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OD
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:MEDEMA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-965-3791
Mailing Address - Street 1:9621 N MILWAUKEE AVE
Mailing Address - Street 2:
Mailing Address - City:NILES
Mailing Address - State:IL
Mailing Address - Zip Code:60714-1116
Mailing Address - Country:US
Mailing Address - Phone:847-965-3791
Mailing Address - Fax:847-965-3947
Practice Address - Street 1:9621 N MILWAUKEE AVE
Practice Address - Street 2:
Practice Address - City:NILES
Practice Address - State:IL
Practice Address - Zip Code:60714-1116
Practice Address - Country:US
Practice Address - Phone:847-965-3791
Practice Address - Fax:847-965-3947
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-12
Last Update Date:2012-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046008031152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty