Provider Demographics
NPI:1952579914
Name:WHEATON EYE CLINIC LTD
Entity Type:Organization
Organization Name:WHEATON EYE CLINIC LTD
Other - Org Name:PLAINFIELD OPTICAL DEPARTMENT
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RUTH
Authorized Official - Middle Name:D
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:630-668-8250
Mailing Address - Street 1:2015 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WHEATON
Mailing Address - State:IL
Mailing Address - Zip Code:60187-3152
Mailing Address - Country:US
Mailing Address - Phone:630-668-8250
Mailing Address - Fax:630-668-9561
Practice Address - Street 1:12426 S. VAN DYKE ROAD
Practice Address - Street 2:
Practice Address - City:PLAINFIELD
Practice Address - State:IL
Practice Address - Zip Code:60585-0000
Practice Address - Country:US
Practice Address - Phone:630-668-8250
Practice Address - Fax:630-668-9561
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WHEATON EYE CLINIC, LTD.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-02-13
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0534150004Medicare NSC