Provider Demographics
NPI:1215204508
Name:IZE VISION CENTER OF BRAIDWOOD, LLC
Entity type:Organization
Organization Name:IZE VISION CENTER OF BRAIDWOOD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:G
Authorized Official - Last Name:ROBINS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:630-653-8885
Mailing Address - Street 1:232 COMET DR
Mailing Address - Street 2:
Mailing Address - City:BRAIDWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60408-2028
Mailing Address - Country:US
Mailing Address - Phone:630-653-8885
Mailing Address - Fax:
Practice Address - Street 1:232 COMET DR
Practice Address - Street 2:
Practice Address - City:BRAIDWOOD
Practice Address - State:IL
Practice Address - Zip Code:60408-2028
Practice Address - Country:US
Practice Address - Phone:630-653-8885
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-30
Last Update Date:2012-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046009229152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty