Provider Demographics
NPI:1427771823
Name:WEST SUBURBAN VISION THERAPY CENTER PC
Entity type:Organization
Organization Name:WEST SUBURBAN VISION THERAPY CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNING OPTOMETRIST
Authorized Official - Prefix:
Authorized Official - First Name:ALICIA
Authorized Official - Middle Name:X
Authorized Official - Last Name:WONG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-491-4941
Mailing Address - Street 1:801 N CASS AVE STE 203
Mailing Address - Street 2:
Mailing Address - City:WESTMONT
Mailing Address - State:IL
Mailing Address - Zip Code:60559-1162
Mailing Address - Country:US
Mailing Address - Phone:630-491-4941
Mailing Address - Fax:630-491-8617
Practice Address - Street 1:801 N CASS AVE STE 203
Practice Address - Street 2:
Practice Address - City:WESTMONT
Practice Address - State:IL
Practice Address - Zip Code:60559-1162
Practice Address - Country:US
Practice Address - Phone:630-491-4941
Practice Address - Fax:630-491-8617
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-21
Last Update Date:2023-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152WV0400XEye and Vision Services ProvidersOptometristVision TherapyGroup - Multi-Specialty
No152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
No152WP0200XEye and Vision Services ProvidersOptometristPediatricsGroup - Multi-Specialty
No152WS0006XEye and Vision Services ProvidersOptometristSports VisionGroup - Multi-Specialty