Provider Demographics
NPI:1952510026
Name:HERZBERG OPTICAL, LLC
Entity Type:Organization
Organization Name:HERZBERG OPTICAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:CARY
Authorized Official - Middle Name:MARK
Authorized Official - Last Name:HERZBERG
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:630-851-3338
Mailing Address - Street 1:2853 E NEW YORK AVENUE
Mailing Address - Street 2:SUITE B
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60502-9091
Mailing Address - Country:US
Mailing Address - Phone:630-851-3338
Mailing Address - Fax:630-851-2740
Practice Address - Street 1:2853 E NEW YORK AVENUE
Practice Address - Street 2:SUITE B
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60502-9091
Practice Address - Country:US
Practice Address - Phone:630-851-3338
Practice Address - Fax:630-851-2740
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL152W00000X, 152WC0802X, 152WP0200X, 152WV0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Not Answered152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact ManagementGroup - Multi-Specialty
Not Answered152WP0200XEye and Vision Services ProvidersOptometristPediatricsGroup - Multi-Specialty
Not Answered152WV0400XEye and Vision Services ProvidersOptometristVision TherapyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL207206Medicare ID - Type UnspecifiedMEDICARE GROUP