Provider Demographics
NPI:1740203850
Name:OSWEGO VISION, LTD
Entity type:Organization
Organization Name:OSWEGO VISION, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:E
Authorized Official - Last Name:HEIN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:630-554-8002
Mailing Address - Street 1:83 TEMPLETON DR
Mailing Address - Street 2:SUITE F
Mailing Address - City:OSWEGO
Mailing Address - State:IL
Mailing Address - Zip Code:60543-7019
Mailing Address - Country:US
Mailing Address - Phone:630-554-8002
Mailing Address - Fax:630-554-8095
Practice Address - Street 1:83 TEMPLETON DR
Practice Address - Street 2:SUITE F
Practice Address - City:OSWEGO
Practice Address - State:IL
Practice Address - Zip Code:60543-7019
Practice Address - Country:US
Practice Address - Phone:630-554-8002
Practice Address - Fax:630-554-8095
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-26
Last Update Date:2009-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046008044152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL4721437OtherBCBS
IL212533Medicare ID - Type Unspecified