Provider Demographics
NPI:1063518322
Name:NORTH SUBURBAN VISION CONSULTANTS,LTD.
Entity type:Organization
Organization Name:NORTH SUBURBAN VISION CONSULTANTS,LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:BARRY
Authorized Official - Last Name:EIDEN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:813-890-8004
Mailing Address - Street 1:360 S WAUKEGAN RD
Mailing Address - Street 2:
Mailing Address - City:DEERFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60015-5654
Mailing Address - Country:US
Mailing Address - Phone:847-412-0311
Mailing Address - Fax:847-412-0316
Practice Address - Street 1:360 S WAUKEGAN RD
Practice Address - Street 2:
Practice Address - City:DEERFIELD
Practice Address - State:IL
Practice Address - Zip Code:60015-5654
Practice Address - Country:US
Practice Address - Phone:847-412-0311
Practice Address - Fax:847-412-0316
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-15
Last Update Date:2013-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL393230Medicare ID - Type Unspecified