Provider Demographics
NPI:1790486207
Name:ADVANCED EYECARE OF HANOVER PARK, CORP.
Entity Type:Organization
Organization Name:ADVANCED EYECARE OF HANOVER PARK, CORP.
Other - Org Name:ADVANCED EYECARE OF HANOVER PARK
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GRISHMA
Authorized Official - Middle Name:P
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-855-5542
Mailing Address - Street 1:1325 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WHEATON
Mailing Address - State:IL
Mailing Address - Zip Code:60187-3579
Mailing Address - Country:US
Mailing Address - Phone:630-668-4144
Mailing Address - Fax:
Practice Address - Street 1:1156 E LAKE ST
Practice Address - Street 2:
Practice Address - City:HANOVER PARK
Practice Address - State:IL
Practice Address - Zip Code:60133-5421
Practice Address - Country:US
Practice Address - Phone:630-855-5542
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-13
Last Update Date:2024-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty