Provider Demographics
NPI:1881834836
Name:SOLO EYE CARE UNIVERSITY VILLAGE
Entity type:Organization
Organization Name:SOLO EYE CARE UNIVERSITY VILLAGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:GREG
Authorized Official - Middle Name:
Authorized Official - Last Name:PAPPAS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:312-588-5999
Mailing Address - Street 1:3460 S HALSTED ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60608-6743
Mailing Address - Country:US
Mailing Address - Phone:312-225-5135
Mailing Address - Fax:312-225-5309
Practice Address - Street 1:1306 S HALSTED ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60607-5022
Practice Address - Country:US
Practice Address - Phone:312-455-1306
Practice Address - Fax:312-455-1310
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-04
Last Update Date:2022-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0460009895152W00000X
IL046009995152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILIL2040Medicare PIN