Provider Demographics
NPI:1487299566
Name:EYE LAND PC
Entity type:Organization
Organization Name:EYE LAND PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:TOMICH
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:773-490-8545
Mailing Address - Street 1:7S651 THORNAPPLE DR
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60540-6293
Mailing Address - Country:US
Mailing Address - Phone:630-328-2906
Mailing Address - Fax:630-328-2927
Practice Address - Street 1:1320 S ROUTE 59
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60564-5944
Practice Address - Country:US
Practice Address - Phone:630-328-2906
Practice Address - Fax:630-328-2927
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-12
Last Update Date:2019-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty