Provider Demographics
NPI:1790855831
Name:ANDERSON EYE ASSOCIATES, LTD
Entity Type:Organization
Organization Name:ANDERSON EYE ASSOCIATES, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-623-8213
Mailing Address - Street 1:713 W OREGON ST
Mailing Address - Street 2:
Mailing Address - City:URBANA
Mailing Address - State:IL
Mailing Address - Zip Code:61801-4047
Mailing Address - Country:US
Mailing Address - Phone:708-623-8213
Mailing Address - Fax:
Practice Address - Street 1:411 CLARENDON AVE
Practice Address - Street 2:SUITE 103
Practice Address - City:SAVOY
Practice Address - State:IL
Practice Address - Zip Code:61874
Practice Address - Country:US
Practice Address - Phone:217-355-7947
Practice Address - Fax:217-355-8047
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-08
Last Update Date:2008-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL042618867174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty