Provider Demographics
NPI:1932407012
Name:DIVINE EYE CARE INC.
Entity Type:Organization
Organization Name:DIVINE EYE CARE INC.
Other - Org Name:OUR VISION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KYUNG
Authorized Official - Middle Name:R
Authorized Official - Last Name:HONG
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:847-581-1891
Mailing Address - Street 1:5630 DEMPSTER ST
Mailing Address - Street 2:
Mailing Address - City:MORTON GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60053-3110
Mailing Address - Country:US
Mailing Address - Phone:847-581-1891
Mailing Address - Fax:847-581-1887
Practice Address - Street 1:5630 DEMPSTER ST
Practice Address - Street 2:
Practice Address - City:MORTON GROVE
Practice Address - State:IL
Practice Address - Zip Code:60053-3110
Practice Address - Country:US
Practice Address - Phone:847-581-1891
Practice Address - Fax:847-581-1887
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-14
Last Update Date:2011-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046008570152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILIL5848Medicare PIN