Provider Demographics
NPI:1790001766
Name:A & G EYECARE INC
Entity Type:Organization
Organization Name:A & G EYECARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY/OPTOMETRIST
Authorized Official - Prefix:
Authorized Official - First Name:GHAZALA
Authorized Official - Middle Name:
Authorized Official - Last Name:ALI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-553-5400
Mailing Address - Street 1:620 W VETERANS PKWY STE D
Mailing Address - Street 2:SUITE D
Mailing Address - City:YORKVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60560-4567
Mailing Address - Country:US
Mailing Address - Phone:630-553-5400
Mailing Address - Fax:
Practice Address - Street 1:620 W VETERANS PKWY
Practice Address - Street 2:SUITE D
Practice Address - City:YORKVILLE
Practice Address - State:IL
Practice Address - Zip Code:60560-4567
Practice Address - Country:US
Practice Address - Phone:630-553-5400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-15
Last Update Date:2013-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILIL3505Medicare PIN
IL6476980001Medicare NSC