Provider Demographics
NPI:1649482258
Name:PRISM EYE CARE, INC.
Entity type:Organization
Organization Name:PRISM EYE CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EIMAN
Authorized Official - Middle Name:
Authorized Official - Last Name:GAFOUR
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:312-342-7007
Mailing Address - Street 1:3448 N MONTICELLO AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60618-5356
Mailing Address - Country:US
Mailing Address - Phone:312-342-7007
Mailing Address - Fax:
Practice Address - Street 1:3448 N MONTICELLO AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60618-5356
Practice Address - Country:US
Practice Address - Phone:312-342-7007
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty