Provider Demographics
NPI:1306314794
Name:ELITE EYE CARE, LLC
Entity type:Organization
Organization Name:ELITE EYE CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:DANIEL
Authorized Official - Last Name:PIETRUSZKA
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:708-256-5135
Mailing Address - Street 1:5438 S 74TH AVE
Mailing Address - Street 2:
Mailing Address - City:SUMMIT
Mailing Address - State:IL
Mailing Address - Zip Code:60501-1013
Mailing Address - Country:US
Mailing Address - Phone:312-614-2020
Mailing Address - Fax:
Practice Address - Street 1:555 S DEARBORN ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60605-1586
Practice Address - Country:US
Practice Address - Phone:312-614-2020
Practice Address - Fax:312-626-5139
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-05
Last Update Date:2018-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty