Provider Demographics
NPI:1760489785
Name:NEW VISION OF ILLINOIS, LLC
Entity Type:Organization
Organization Name:NEW VISION OF ILLINOIS, LLC
Other - Org Name:BRIGHTBILL-ERICSON EYE ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:FREDERICK
Authorized Official - Middle Name:STAMM
Authorized Official - Last Name:BRIGHTBILL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:815-654-2020
Mailing Address - Street 1:2929 MCFARLAND ROAD
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61107
Mailing Address - Country:US
Mailing Address - Phone:815-654-2020
Mailing Address - Fax:815-654-0393
Practice Address - Street 1:2929 MCFARLAND ROAD
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61107
Practice Address - Country:US
Practice Address - Phone:815-654-2020
Practice Address - Fax:815-654-0393
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL203372Medicare ID - Type UnspecifiedMEDICARE GROUP