Provider Demographics
NPI:1972841393
Name:CENTRAL DUPAGE VISION CENTER INC.
Entity Type:Organization
Organization Name:CENTRAL DUPAGE VISION CENTER INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ATHA
Authorized Official - Middle Name:
Authorized Official - Last Name:HYDERI
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:630-668-2020
Mailing Address - Street 1:27W185 GENEVA RD
Mailing Address - Street 2:
Mailing Address - City:WINFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60190-2058
Mailing Address - Country:US
Mailing Address - Phone:630-668-2020
Mailing Address - Fax:630-668-0308
Practice Address - Street 1:27W185 GENEVA RD
Practice Address - Street 2:
Practice Address - City:WINFIELD
Practice Address - State:IL
Practice Address - Zip Code:60190-2058
Practice Address - Country:US
Practice Address - Phone:630-668-2020
Practice Address - Fax:630-668-0308
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-18
Last Update Date:2013-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046009463152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL046009463Medicaid
U92374Medicare UPIN
IL046009463Medicaid