Provider Demographics
NPI:1932507902
Name:EYE CARE CENTER OF LAKE COUNTY, LTD
Entity Type:Organization
Organization Name:EYE CARE CENTER OF LAKE COUNTY, LTD
Other - Org Name:EYE CARE CENTER OF LAKE COUNTY
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER & PRESIDENT OF CORPORATION
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:D
Authorized Official - Last Name:REINGLASS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-244-1657
Mailing Address - Street 1:310 S GREENLEAF ST
Mailing Address - Street 2:SUITE 209
Mailing Address - City:GURNEE
Mailing Address - State:IL
Mailing Address - Zip Code:60031-5708
Mailing Address - Country:US
Mailing Address - Phone:847-244-1657
Mailing Address - Fax:847-244-5122
Practice Address - Street 1:310 S GREENLEAF ST
Practice Address - Street 2:SUITE 209
Practice Address - City:GURNEE
Practice Address - State:IL
Practice Address - Zip Code:60031-5708
Practice Address - Country:US
Practice Address - Phone:847-244-1657
Practice Address - Fax:847-244-5122
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-08
Last Update Date:2014-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046009099152W00000X
IL046009954152W00000X
IL036067575261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
No152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty