Provider Demographics
NPI:1023243847
Name:FOX VALLEY LASER CENTER
Entity type:Organization
Organization Name:FOX VALLEY LASER CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CARYL
Authorized Official - Middle Name:J
Authorized Official - Last Name:MARKS
Authorized Official - Suffix:
Authorized Official - Credentials:COE
Authorized Official - Phone:630-355-6222
Mailing Address - Street 1:1960 SPRINGBROOK SQUARE DR STE 110
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60564-5959
Mailing Address - Country:US
Mailing Address - Phone:630-355-6222
Mailing Address - Fax:630-355-6219
Practice Address - Street 1:1960 SPRINGBROOK SQUARE DR STE 110
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60564-5959
Practice Address - Country:US
Practice Address - Phone:630-355-6222
Practice Address - Fax:630-355-6219
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-22
Last Update Date:2009-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty