Provider Demographics
NPI:1841422938
Name:NAPERVILLE VISION CENTER, LTD
Entity Type:Organization
Organization Name:NAPERVILLE VISION CENTER, LTD
Other - Org Name:VISION CARE GROUP, NAPERVILLE VISION CARE, PLAINFIELD VISION CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:BOOTS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:630-961-5255
Mailing Address - Street 1:1783 S WASHINGTON ST
Mailing Address - Street 2:SUITE 111
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60565-2462
Mailing Address - Country:US
Mailing Address - Phone:630-961-5255
Mailing Address - Fax:630-961-0335
Practice Address - Street 1:1783 S WASHINGTON ST
Practice Address - Street 2:SUITE 111
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60565-2462
Practice Address - Country:US
Practice Address - Phone:630-961-5255
Practice Address - Fax:630-961-0335
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-22
Last Update Date:2009-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILIL-046008982152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL585280Medicare PIN
ILU65182Medicare UPIN