Provider Demographics
NPI:1851301006
Name:FORZLEY EYE CLINIC LTD
Entity Type:Organization
Organization Name:FORZLEY EYE CLINIC LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER OPTOMETRIST
Authorized Official - Prefix:
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:FORZLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-243-2020
Mailing Address - Street 1:1192 WALTER ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:LEMONT
Mailing Address - State:IL
Mailing Address - Zip Code:60439-2905
Mailing Address - Country:US
Mailing Address - Phone:630-243-2020
Mailing Address - Fax:630-243-1100
Practice Address - Street 1:1192 WALTER ST
Practice Address - Street 2:SUITE A
Practice Address - City:LEMONT
Practice Address - State:IL
Practice Address - Zip Code:60439-2905
Practice Address - Country:US
Practice Address - Phone:630-243-2020
Practice Address - Fax:630-243-1100
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-09
Last Update Date:2007-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
0001621941OtherBLUE CROSS BLUE SHIELD IL
1207690001OtherDMERC REGION B
410042845OtherRAILROAD MEDICARE
1207690001OtherDMERC REGION B