Provider Demographics
NPI:1033215447
Name:SPECTRIOS INSTITUTE FOR LOW VISION
Entity type:Organization
Organization Name:SPECTRIOS INSTITUTE FOR LOW VISION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:R
Authorized Official - Middle Name:TRACY
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:630-690-7115
Mailing Address - Street 1:219 E COLE AVE
Mailing Address - Street 2:
Mailing Address - City:WHEATON
Mailing Address - State:IL
Mailing Address - Zip Code:60187
Mailing Address - Country:US
Mailing Address - Phone:630-690-7115
Mailing Address - Fax:630-690-9037
Practice Address - Street 1:219 E COLE AVE
Practice Address - Street 2:
Practice Address - City:WHEATON
Practice Address - State:IL
Practice Address - Zip Code:60187
Practice Address - Country:US
Practice Address - Phone:630-690-7115
Practice Address - Fax:630-690-9037
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-15
Last Update Date:2015-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152WL0500XEye and Vision Services ProvidersOptometristLow Vision RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
0002221432OtherBLUE CROSS BLUE SHIELD
0002221432OtherBLUE CROSS BLUE SHIELD