Provider Demographics
NPI:1831510056
Name:EYETOPIA, INC
Entity type:Organization
Organization Name:EYETOPIA, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RANDALL
Authorized Official - Middle Name:F
Authorized Official - Last Name:AKEL
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:708-785-1045
Mailing Address - Street 1:585 RIVER OAKS W
Mailing Address - Street 2:
Mailing Address - City:CALUMET CITY
Mailing Address - State:IL
Mailing Address - Zip Code:60409-5443
Mailing Address - Country:US
Mailing Address - Phone:708-891-8600
Mailing Address - Fax:
Practice Address - Street 1:585 RIVER OAKS W
Practice Address - Street 2:
Practice Address - City:CALUMET CITY
Practice Address - State:IL
Practice Address - Zip Code:60409-5443
Practice Address - Country:US
Practice Address - Phone:708-891-8600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-16
Last Update Date:2013-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046008463152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL266359622Medicaid
IL1114944964OtherIRS INDIVIDUAL NPI
IL1336335991Medicare UPIN