Provider Demographics
NPI:1982982385
Name:CLARENDON VISION DEVELOPMENT CENTER
Entity Type:Organization
Organization Name:CLARENDON VISION DEVELOPMENT CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MONIKA
Authorized Official - Middle Name:
Authorized Official - Last Name:SPOKAS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:630-640-6769
Mailing Address - Street 1:760 PASQUINELLI DR STE 300
Mailing Address - Street 2:
Mailing Address - City:WESTMONT
Mailing Address - State:IL
Mailing Address - Zip Code:60559-1290
Mailing Address - Country:US
Mailing Address - Phone:630-323-7300
Mailing Address - Fax:
Practice Address - Street 1:760 PASQUINELLI DR STE 300
Practice Address - Street 2:
Practice Address - City:WESTMONT
Practice Address - State:IL
Practice Address - Zip Code:60559-1290
Practice Address - Country:US
Practice Address - Phone:630-323-7300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-02
Last Update Date:2023-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046009498152WV0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152WV0400XEye and Vision Services ProvidersOptometristVision TherapyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1982982385Medicaid
ILIL6329Medicare PIN