Provider Demographics
NPI:1831287861
Name:VISION SALON EYE CARE ASSOCIATES
Entity Type:Organization
Organization Name:VISION SALON EYE CARE ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANSEL
Authorized Official - Middle Name:T
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:773-783-4424
Mailing Address - Street 1:840 E 87TH ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60619-6248
Mailing Address - Country:US
Mailing Address - Phone:773-783-4424
Mailing Address - Fax:773-783-3340
Practice Address - Street 1:840 E 87TH ST
Practice Address - Street 2:SUITE 100
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60619-6248
Practice Address - Country:US
Practice Address - Phone:773-783-4424
Practice Address - Fax:773-783-3340
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1636075OtherBCBS OF IL ID
=========OtherTAX ID
0718670001Medicare NSC
IL1636075OtherBCBS OF IL ID