Provider Demographics
NPI:1922513928
Name:SPRINGDALE EYECARE LLC
Entity Type:Organization
Organization Name:SPRINGDALE EYECARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:TANYA
Authorized Official - Middle Name:
Authorized Official - Last Name:HALIKIAS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:312-912-1812
Mailing Address - Street 1:10701 CHERRYWOOD DR
Mailing Address - Street 2:
Mailing Address - City:PALOS PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60464-3701
Mailing Address - Country:US
Mailing Address - Phone:312-912-1812
Mailing Address - Fax:
Practice Address - Street 1:5450 WOLF RD
Practice Address - Street 2:
Practice Address - City:WESTERN SPRINGS
Practice Address - State:IL
Practice Address - Zip Code:60558-1852
Practice Address - Country:US
Practice Address - Phone:708-820-2020
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-12
Last Update Date:2017-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL46009983261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center