Provider Demographics
NPI:1861668345
Name:VIKING EYECARE LLC
Entity Type:Organization
Organization Name:VIKING EYECARE LLC
Other - Org Name:PEARLE VISION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:T
Authorized Official - Last Name:TWEED
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:630-845-9110
Mailing Address - Street 1:1749 S RANDALL RD STE F
Mailing Address - Street 2:
Mailing Address - City:GENEVA
Mailing Address - State:IL
Mailing Address - Zip Code:60134-4616
Mailing Address - Country:US
Mailing Address - Phone:630-845-9110
Mailing Address - Fax:630-845-9118
Practice Address - Street 1:1749 S RANDALL RD STE F
Practice Address - Street 2:
Practice Address - City:GENEVA
Practice Address - State:IL
Practice Address - Zip Code:60134-4616
Practice Address - Country:US
Practice Address - Phone:630-845-9110
Practice Address - Fax:630-845-9118
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-05
Last Update Date:2009-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046009196152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL6144360001Medicare NSC