Provider Demographics
NPI:1720171515
Name:PROFESSIONAL EYE CARE CENTER, INC.
Entity Type:Organization
Organization Name:PROFESSIONAL EYE CARE CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:A
Authorized Official - Last Name:LOWE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:773-774-3939
Mailing Address - Street 1:7225 N CALDWELL AVE
Mailing Address - Street 2:
Mailing Address - City:NILES
Mailing Address - State:IL
Mailing Address - Zip Code:60714-4548
Mailing Address - Country:US
Mailing Address - Phone:847-647-0707
Mailing Address - Fax:847-647-1402
Practice Address - Street 1:7225 N CALDWELL AVE
Practice Address - Street 2:
Practice Address - City:NILES
Practice Address - State:IL
Practice Address - Zip Code:60714-4548
Practice Address - Country:US
Practice Address - Phone:847-647-0707
Practice Address - Fax:847-647-1402
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2010-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL207943Medicare ID - Type Unspecified