Provider Demographics
NPI:1194016717
Name:PLAINFIELD VISION CENTER LLC
Entity type:Organization
Organization Name:PLAINFIELD VISION CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KETAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SHELADIA
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:708-482-7744
Mailing Address - Street 1:5501 W PLAINFIELD RD
Mailing Address - Street 2:
Mailing Address - City:COUNTRYSIDE
Mailing Address - State:IL
Mailing Address - Zip Code:60525-3591
Mailing Address - Country:US
Mailing Address - Phone:708-482-7744
Mailing Address - Fax:
Practice Address - Street 1:5501 W PLAINFIELD RD
Practice Address - Street 2:
Practice Address - City:COUNTRYSIDE
Practice Address - State:IL
Practice Address - Zip Code:60525-3591
Practice Address - Country:US
Practice Address - Phone:708-482-7744
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-30
Last Update Date:2011-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046009646152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty