Provider Demographics
NPI:1689753675
Name:MARVIN H HEIMLICH,OD LLC
Entity Type:Organization
Organization Name:MARVIN H HEIMLICH,OD LLC
Other - Org Name:LIBERTYVILLE VISION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARVIN
Authorized Official - Middle Name:HAROLD
Authorized Official - Last Name:HEIMLICH
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:847-362-6444
Mailing Address - Street 1:307 S MILWAUKEE AVE
Mailing Address - Street 2:LIBERTYVILLE VISION CENTER
Mailing Address - City:LIBERTYVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60048
Mailing Address - Country:US
Mailing Address - Phone:847-362-3444
Mailing Address - Fax:847-362-4672
Practice Address - Street 1:307 S MILWAUKEE AVE
Practice Address - Street 2:LIBERTYVILLE VISION CENTER
Practice Address - City:LIBERTYVILLE
Practice Address - State:IL
Practice Address - Zip Code:60048
Practice Address - Country:US
Practice Address - Phone:847-362-3444
Practice Address - Fax:847-362-4672
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-02
Last Update Date:2009-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL4915133OtherBLUE CROSS/BLUE SHIELD
ILIL7448-001OtherEYEMED VISION CARE
IL2116789OtherAETNA
IL0499260002Medicare NSC
ILIL7448-001OtherEYEMED VISION CARE