Provider Demographics
NPI:1396271235
Name:FAMILY EYECARE ALEXIS E SCATCHELL OD
Entity type:Organization
Organization Name:FAMILY EYECARE ALEXIS E SCATCHELL OD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:ALEXANDRIA
Authorized Official - Middle Name:E
Authorized Official - Last Name:SCATCHELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-458-3230
Mailing Address - Street 1:5355 W DEVON AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60646-4142
Mailing Address - Country:US
Mailing Address - Phone:773-930-4035
Mailing Address - Fax:
Practice Address - Street 1:5355 W DEVON AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60646-4142
Practice Address - Country:US
Practice Address - Phone:773-930-4035
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-11
Last Update Date:2023-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth ServiceGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL046009919Medicaid