Provider Demographics
NPI:1316088305
Name:SENIOR EYE ASSOCIATES SC
Entity type:Organization
Organization Name:SENIOR EYE ASSOCIATES SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:CHRISTOPHER
Authorized Official - Last Name:BARNES
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:773-792-1011
Mailing Address - Street 1:PO BOX 2354
Mailing Address - Street 2:
Mailing Address - City:NORTHBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60065-2354
Mailing Address - Country:US
Mailing Address - Phone:773-792-1011
Mailing Address - Fax:773-889-0224
Practice Address - Street 1:6601 N AVONDALE AVE STE 102
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60631-1567
Practice Address - Country:US
Practice Address - Phone:773-792-1011
Practice Address - Fax:773-889-0224
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-10
Last Update Date:2023-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1622243OtherBCBS IL GROUP NUMBER
IL486270Medicare ID - Type UnspecifiedGROUP NUMBER
ILCI2721Medicare ID - Type UnspecifiedRAILROAD GROUP NUMBER
IL622650Medicare ID - Type UnspecifiedGROUP NUMBER
IL1238060001Medicare NSC