Provider Demographics
NPI:1083661029
Name:PRIMARY EYE CARE CENTERS, PC
Entity type:Organization
Organization Name:PRIMARY EYE CARE CENTERS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:C
Authorized Official - Last Name:HILLMANN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:815-209-9420
Mailing Address - Street 1:1603 N ALPINE RD
Mailing Address - Street 2:ST 121
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61107-1439
Mailing Address - Country:US
Mailing Address - Phone:815-209-9420
Mailing Address - Fax:
Practice Address - Street 1:1603 N ALPINE RD
Practice Address - Street 2:ST 121
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61107-1439
Practice Address - Country:US
Practice Address - Phone:815-209-9420
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-27
Last Update Date:2013-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL213377Medicare PIN