Provider Demographics
NPI:1760541775
Name:FRONTIER FAMILY VISION INC
Entity Type:Organization
Organization Name:FRONTIER FAMILY VISION INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KYLE
Authorized Official - Middle Name:W
Authorized Official - Last Name:RIPPEL
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:630-922-8000
Mailing Address - Street 1:2879 W 95TH
Mailing Address - Street 2:SUITE 179
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60564
Mailing Address - Country:US
Mailing Address - Phone:630-922-8000
Mailing Address - Fax:630-922-7754
Practice Address - Street 1:2879 W 95TH
Practice Address - Street 2:SUITE 179
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60564
Practice Address - Country:US
Practice Address - Phone:630-922-8000
Practice Address - Fax:630-922-7754
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILP00233958OtherPALMETTO GBA
IL09932396OtherBLUE CROSS BLUE SHIELD
IL203933Medicare ID - Type Unspecified
U60847Medicare UPIN