Provider Demographics
NPI:1013049832
Name:COMBS EYECARE AND EYEWEAR LTD
Entity Type:Organization
Organization Name:COMBS EYECARE AND EYEWEAR LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:IRENE
Authorized Official - Middle Name:DOMENICA
Authorized Official - Last Name:COMBS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:708-286-1100
Mailing Address - Street 1:504 HILLGROVE AVE
Mailing Address - Street 2:
Mailing Address - City:WESTERN SPRINGS
Mailing Address - State:IL
Mailing Address - Zip Code:60558-1481
Mailing Address - Country:US
Mailing Address - Phone:708-286-1100
Mailing Address - Fax:708-286-1103
Practice Address - Street 1:504 HILLGROVE AVE
Practice Address - Street 2:
Practice Address - City:WESTERN SPRINGS
Practice Address - State:IL
Practice Address - Zip Code:60558-1481
Practice Address - Country:US
Practice Address - Phone:708-286-1100
Practice Address - Fax:708-286-1103
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-09
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046008409332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL5850140001Medicare NSC