Provider Demographics
NPI:1851899082
Name:CARR EYE PROFESSIONALS PC
Entity Type:Organization
Organization Name:CARR EYE PROFESSIONALS PC
Other - Org Name:MT. GREENWOOD EYE PROFESSIONALS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATIVE ASSISTANT
Authorized Official - Prefix:MRS
Authorized Official - First Name:CINDY
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHUTT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-361-6141
Mailing Address - Street 1:14225 S 95TH AVE STE 453
Mailing Address - Street 2:
Mailing Address - City:ORLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60462-2266
Mailing Address - Country:US
Mailing Address - Phone:708-361-6141
Mailing Address - Fax:708-361-5327
Practice Address - Street 1:3225 W 111TH ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60655-2745
Practice Address - Country:US
Practice Address - Phone:773-238-2142
Practice Address - Fax:773-238-9461
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CARR EYE PROFESSIONALS PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-01-23
Last Update Date:2018-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========Medicaid