Provider Demographics
NPI:1356559595
Name:CONCEPT EYE CARE, LTD.
Entity type:Organization
Organization Name:CONCEPT EYE CARE, LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:LORRAIN
Authorized Official - Last Name:REYNOLDS-TEMPLE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:773-363-0202
Mailing Address - Street 1:1605 E 55TH ST
Mailing Address - Street 2:1ST FLR
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60615-5803
Mailing Address - Country:US
Mailing Address - Phone:773-363-0202
Mailing Address - Fax:773-363-0201
Practice Address - Street 1:1605 E 55TH ST
Practice Address - Street 2:1ST FLR
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60615-5803
Practice Address - Country:US
Practice Address - Phone:773-363-0202
Practice Address - Fax:773-363-0201
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-20
Last Update Date:2007-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0046008464152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact ManagementGroup - Single Specialty