Provider Demographics
NPI:1881992469
Name:VESNA SIMIC, INC.
Entity type:Organization
Organization Name:VESNA SIMIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:VESNA
Authorized Official - Middle Name:
Authorized Official - Last Name:SIMIC
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:847-940-0523
Mailing Address - Street 1:775 WAUKEGAN RD
Mailing Address - Street 2:SUITE 170
Mailing Address - City:DEERFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60015-4342
Mailing Address - Country:US
Mailing Address - Phone:847-940-0523
Mailing Address - Fax:847-940-0543
Practice Address - Street 1:775 WAUKEGAN RD
Practice Address - Street 2:SUITE 170
Practice Address - City:DEERFIELD
Practice Address - State:IL
Practice Address - Zip Code:60015-4342
Practice Address - Country:US
Practice Address - Phone:847-940-0523
Practice Address - Fax:847-940-0543
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-07
Last Update Date:2011-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046009401152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty