Provider Demographics
NPI:1285923680
Name:BNL EYECARE INC.
Entity type:Organization
Organization Name:BNL EYECARE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DREW
Authorized Official - Middle Name:
Authorized Official - Last Name:KLEIN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:847-962-1877
Mailing Address - Street 1:2225 W MARKET ST
Mailing Address - Street 2:VISION CENTER
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:61705-5014
Mailing Address - Country:US
Mailing Address - Phone:309-829-0636
Mailing Address - Fax:
Practice Address - Street 1:2225 W MARKET ST
Practice Address - Street 2:VISION CENTER
Practice Address - City:BLOOMINGTON
Practice Address - State:IL
Practice Address - Zip Code:61705-5014
Practice Address - Country:US
Practice Address - Phone:309-829-0636
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-06
Last Update Date:2011-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046007201152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL046007201Medicaid