Provider Demographics
NPI:1457618621
Name:EYE 2 EYE VISION CENTER PC
Entity Type:Organization
Organization Name:EYE 2 EYE VISION CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:CUTLER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:815-729-9143
Mailing Address - Street 1:2537 PLAINFIELD RD
Mailing Address - Street 2:
Mailing Address - City:JOLIET
Mailing Address - State:IL
Mailing Address - Zip Code:60435-1463
Mailing Address - Country:US
Mailing Address - Phone:815-577-2020
Mailing Address - Fax:815-577-0998
Practice Address - Street 1:2537 PLAINFIELD RD
Practice Address - Street 2:
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60435-1463
Practice Address - Country:US
Practice Address - Phone:815-577-2020
Practice Address - Fax:815-577-0998
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-12
Last Update Date:2012-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046009118152W00000X
IL046009198152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL046009118Medicaid
IL09932266OtherBLUE CROSS BLUE SHIELD
IL0009919581OtherBLUE CROSS BLUE SHIELD
IL046009198Medicaid
IL1619205077Medicare NSC
IL046009118Medicaid
IL210081Medicare PIN
IL5306320001Medicare NSC
IL09932266OtherBLUE CROSS BLUE SHIELD
ILU72940Medicare UPIN