Provider Demographics
NPI:1265736078
Name:TC EYECARE, PC
Entity type:Organization
Organization Name:TC EYECARE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:J
Authorized Official - Last Name:COWAN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:239-443-8144
Mailing Address - Street 1:822 MARION AVE
Mailing Address - Street 2:
Mailing Address - City:GENEVA
Mailing Address - State:IL
Mailing Address - Zip Code:60134-3246
Mailing Address - Country:US
Mailing Address - Phone:239-443-8144
Mailing Address - Fax:
Practice Address - Street 1:6800 W US HIGHWAY 34
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:IL
Practice Address - Zip Code:60545-9607
Practice Address - Country:US
Practice Address - Phone:630-552-1593
Practice Address - Fax:630-552-1595
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-07
Last Update Date:2011-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046008730152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty