Provider Demographics
NPI:1902388754
Name:EYEMAX INC.
Entity Type:Organization
Organization Name:EYEMAX INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:K
Authorized Official - Last Name:AUNG-KUNIMURA
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:630-425-8221
Mailing Address - Street 1:2620 HIGH MEADOW RD
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60564-4322
Mailing Address - Country:US
Mailing Address - Phone:630-730-3093
Mailing Address - Fax:
Practice Address - Street 1:2003 MONTGOMERY RD STE 104
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60504-9059
Practice Address - Country:US
Practice Address - Phone:630-425-8221
Practice Address - Fax:630-425-8222
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-29
Last Update Date:2019-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046-009528152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL046009528Medicaid