Provider Demographics
NPI:1265973036
Name:BOLINGBROOK EYE CARE & EYEWEAR GALLERY, LLC
Entity type:Organization
Organization Name:BOLINGBROOK EYE CARE & EYEWEAR GALLERY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:VARNEY
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:319-404-7565
Mailing Address - Street 1:124 E BOUGHTON RD
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-2014
Mailing Address - Country:US
Mailing Address - Phone:630-358-4533
Mailing Address - Fax:630-348-8133
Practice Address - Street 1:124 E BOUGHTON RD
Practice Address - Street 2:
Practice Address - City:BOLINGBROOK
Practice Address - State:IL
Practice Address - Zip Code:60440-2014
Practice Address - Country:US
Practice Address - Phone:630-358-4533
Practice Address - Fax:630-348-8133
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-13
Last Update Date:2017-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046010458152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty