Provider Demographics
NPI:1689780645
Name:EYES ON THE LAKE, PC
Entity Type:Organization
Organization Name:EYES ON THE LAKE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:R
Authorized Official - Last Name:NAJEM
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:847-853-1111
Mailing Address - Street 1:420 GREEN BAY RD.
Mailing Address - Street 2:
Mailing Address - City:KENILWORTH
Mailing Address - State:IL
Mailing Address - Zip Code:60043-1075
Mailing Address - Country:US
Mailing Address - Phone:847-853-1111
Mailing Address - Fax:
Practice Address - Street 1:420 GREEN BAY RD
Practice Address - Street 2:
Practice Address - City:KENILWORTH
Practice Address - State:IL
Practice Address - Zip Code:60043-1075
Practice Address - Country:US
Practice Address - Phone:847-853-1111
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046-09022152W00000X
IL046-08599152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty