Provider Demographics
NPI:1750566188
Name:THE MIND-EYE CONNECTION PC
Entity type:Organization
Organization Name:THE MIND-EYE CONNECTION PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:GAIL
Authorized Official - Last Name:ZELINSKY
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:847-501-2020
Mailing Address - Street 1:1414 TECHNY RD
Mailing Address - Street 2:
Mailing Address - City:NORTHBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60062-5447
Mailing Address - Country:US
Mailing Address - Phone:847-501-2020
Mailing Address - Fax:847-501-2021
Practice Address - Street 1:1414 TECHNY RD
Practice Address - Street 2:
Practice Address - City:NORTHBROOK
Practice Address - State:IL
Practice Address - Zip Code:60062-5447
Practice Address - Country:US
Practice Address - Phone:847-501-2020
Practice Address - Fax:847-501-2021
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-03
Last Update Date:2016-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046007834152WL0500X, 152WP0200X, 152WV0400X, 152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
No152WL0500XEye and Vision Services ProvidersOptometristLow Vision RehabilitationGroup - Multi-Specialty
No152WP0200XEye and Vision Services ProvidersOptometristPediatricsGroup - Multi-Specialty
No152WV0400XEye and Vision Services ProvidersOptometristVision TherapyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL983340OtherBC/BS ILLINOIS
IL208386OtherGROUP NUMBER
IL983340OtherBC/BS ILLINOIS
IL208386Medicare UPIN
ILT85272Medicare UPIN
IL208386Medicare PIN
ILK04119Medicare PIN