Provider Demographics
NPI:1891188199
Name:MWB VISION INC
Entity Type:Organization
Organization Name:MWB VISION INC
Other - Org Name:4SIGHT ICARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:W
Authorized Official - Last Name:BURKE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:815-915-4047
Mailing Address - Street 1:2194 KEMMERER LN
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60490-5037
Mailing Address - Country:US
Mailing Address - Phone:773-425-0732
Mailing Address - Fax:
Practice Address - Street 1:11914 S ROUTE 59
Practice Address - Street 2:UNIT 106
Practice Address - City:PLAINFIELD
Practice Address - State:IL
Practice Address - Zip Code:60585-5110
Practice Address - Country:US
Practice Address - Phone:815-915-4047
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-11
Last Update Date:2015-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046010336152WS0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152WS0006XEye and Vision Services ProvidersOptometristSports VisionGroup - Multi-Specialty