Provider Demographics
NPI:1013099670
Name:NAPERVILLE EYE ASSOCIATES LTD
Entity type:Organization
Organization Name:NAPERVILLE EYE ASSOCIATES LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JEFF
Authorized Official - Middle Name:
Authorized Official - Last Name:NICHOLS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-357-5280
Mailing Address - Street 1:1855 BAY SCOTT CIR
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60540-1104
Mailing Address - Country:US
Mailing Address - Phone:630-357-5280
Mailing Address - Fax:630-357-5367
Practice Address - Street 1:1855 BAY SCOTT CIR
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60540-1104
Practice Address - Country:US
Practice Address - Phone:630-357-5280
Practice Address - Fax:630-357-5367
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-20
Last Update Date:2015-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-041747207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0960010002Medicare NSC
IL775840Medicare ID - Type Unspecified