Provider Demographics
NPI:1760689814
Name:MLSNA FAMILY EYE CARE SC
Entity Type:Organization
Organization Name:MLSNA FAMILY EYE CARE SC
Other - Org Name:ROCHELLE EYE CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:REID
Authorized Official - Middle Name:E
Authorized Official - Last Name:MLSNA
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:815-562-6175
Mailing Address - Street 1:719 LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:ROCHELLE
Mailing Address - State:IL
Mailing Address - Zip Code:61068-1867
Mailing Address - Country:US
Mailing Address - Phone:815-562-6175
Mailing Address - Fax:815-562-5037
Practice Address - Street 1:719 LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:ROCHELLE
Practice Address - State:IL
Practice Address - Zip Code:61068-1867
Practice Address - Country:US
Practice Address - Phone:815-562-6175
Practice Address - Fax:815-562-5037
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-02
Last Update Date:2007-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL047.933091152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty