Provider Demographics
NPI:1881727741
Name:EYE PHYSICIANS OF KANKAKEE,LTD
Entity type:Organization
Organization Name:EYE PHYSICIANS OF KANKAKEE,LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPHTHALMOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:J
Authorized Official - Last Name:BURNS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:815-933-5202
Mailing Address - Street 1:372 LARRY POWER RD
Mailing Address - Street 2:SUITE1
Mailing Address - City:BOURBONNAIS
Mailing Address - State:IL
Mailing Address - Zip Code:60914-5190
Mailing Address - Country:US
Mailing Address - Phone:815-933-5202
Mailing Address - Fax:815-933-6531
Practice Address - Street 1:372 LARRY POWER RD
Practice Address - Street 2:SUITE1
Practice Address - City:BOURBONNAIS
Practice Address - State:IL
Practice Address - Zip Code:60914-5190
Practice Address - Country:US
Practice Address - Phone:815-933-5202
Practice Address - Fax:815-933-6531
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-13
Last Update Date:2011-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036103938332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036103938Medicaid
IL036103938Medicaid