Provider Demographics
NPI:1386311900
Name:REENVISION EYECARE, S.C.
Entity type:Organization
Organization Name:REENVISION EYECARE, S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KRISTI
Authorized Official - Middle Name:LYN
Authorized Official - Last Name:KOZLOV
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:312-771-2007
Mailing Address - Street 1:355 W DUNDEE RD # SUIE110
Mailing Address - Street 2:
Mailing Address - City:BUFFALO GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60089-3500
Mailing Address - Country:US
Mailing Address - Phone:847-541-4878
Mailing Address - Fax:847-520-0500
Practice Address - Street 1:355 W DUNDEE RD # SUIE110
Practice Address - Street 2:
Practice Address - City:BUFFALO GROVE
Practice Address - State:IL
Practice Address - Zip Code:60089-3500
Practice Address - Country:US
Practice Address - Phone:847-541-4878
Practice Address - Fax:847-520-0500
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-23
Last Update Date:2021-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207WX0120XAllopathic & Osteopathic PhysiciansOphthalmologyCornea and External Diseases SpecialistGroup - Single Specialty