Provider Demographics
NPI:1811392517
Name:EASY OPTICAL EYE CARE INC.
Entity Type:Organization
Organization Name:EASY OPTICAL EYE CARE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMIN
Authorized Official - Prefix:
Authorized Official - First Name:VYTAUTAS
Authorized Official - Middle Name:
Authorized Official - Last Name:TAMULIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:815-483-9504
Mailing Address - Street 1:3457 W 111TH ST.
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60655
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3457 W 111TH ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60655-3335
Practice Address - Country:US
Practice Address - Phone:773-253-2175
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-24
Last Update Date:2014-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046009691152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty