Provider Demographics
NPI:1821129834
Name:ARBOR CENTER FOR EYECARE
Entity Type:Organization
Organization Name:ARBOR CENTER FOR EYECARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTICAL MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:
Authorized Official - Last Name:GLENN
Authorized Official - Suffix:
Authorized Official - Credentials:ABOC
Authorized Official - Phone:708-798-6633
Mailing Address - Street 1:2640 WEST 183RD STREET
Mailing Address - Street 2:
Mailing Address - City:HOMEWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60430
Mailing Address - Country:US
Mailing Address - Phone:708-798-6633
Mailing Address - Fax:708-798-4486
Practice Address - Street 1:2640 WEST 183RD ST
Practice Address - Street 2:
Practice Address - City:HOMEWOOD
Practice Address - State:IL
Practice Address - Zip Code:60430
Practice Address - Country:US
Practice Address - Phone:708-798-6633
Practice Address - Fax:708-798-4486
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-08
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies