Provider Demographics
NPI:1700830957
Name:ELIGIJUS P. LELIS M.D. & ASSOCIATES, S.C.
Entity Type:Organization
Organization Name:ELIGIJUS P. LELIS M.D. & ASSOCIATES, S.C.
Other - Org Name:SPECTRUM EYE INSTITUTE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ELIGIJUS
Authorized Official - Middle Name:P
Authorized Official - Last Name:LELIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:815-729-3777
Mailing Address - Street 1:963 N. 129TH INFANTRY DR
Mailing Address - Street 2:SUITE 110
Mailing Address - City:JOLIET
Mailing Address - State:IL
Mailing Address - Zip Code:60435-3103
Mailing Address - Country:US
Mailing Address - Phone:815-729-3777
Mailing Address - Fax:815-725-9358
Practice Address - Street 1:963 N 129TH INFANTRY DR
Practice Address - Street 2:STE 110
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60435-3103
Practice Address - Country:US
Practice Address - Phone:815-729-3777
Practice Address - Fax:815-725-9358
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-20
Last Update Date:2016-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILCG9902OtherRR MEDICARE
IL0009919581OtherBLUE CROSS BLUE SHIELD IL
IL211599Medicare PIN
IL0009919581OtherBLUE CROSS BLUE SHIELD IL
IL211623Medicare PIN
IL1780710780Medicare NSC
IL211624Medicare PIN
IL0857370001Medicare NSC
IL0857370002Medicare NSC