Provider Demographics
NPI:1184752289
Name:ELGIN EYE CARE
Entity type:Organization
Organization Name:ELGIN EYE CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROLAND
Authorized Official - Middle Name:
Authorized Official - Last Name:BRAND
Authorized Official - Suffix:
Authorized Official - Credentials:ABO CERT OPTICIAN
Authorized Official - Phone:847-488-1588
Mailing Address - Street 1:840 SUMMIT ST
Mailing Address - Street 2:SUITE G
Mailing Address - City:ELGIN
Mailing Address - State:IL
Mailing Address - Zip Code:60120-4300
Mailing Address - Country:US
Mailing Address - Phone:847-488-1588
Mailing Address - Fax:847-628-2320
Practice Address - Street 1:840 SUMMIT ST
Practice Address - Street 2:SUITE G
Practice Address - City:ELGIN
Practice Address - State:IL
Practice Address - Zip Code:60120-4300
Practice Address - Country:US
Practice Address - Phone:847-488-1588
Practice Address - Fax:847-628-2320
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL5502-6052305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILOP1280OtherEYEMED VISION CARE
ILELGINEYECAREOtherMIDAMERICA VISION
ILEE25556OtherSPECTERA
ILSVS1641OtherSUPERIOR VISION