Provider Demographics
NPI:1487765251
Name:PORRETTA EYECARE, P.C.
Entity type:Organization
Organization Name:PORRETTA EYECARE, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:THERESE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:PORRETTA
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:847-458-5796
Mailing Address - Street 1:620 ECHO TRL
Mailing Address - Street 2:
Mailing Address - City:MARENGO
Mailing Address - State:IL
Mailing Address - Zip Code:60152-8058
Mailing Address - Country:US
Mailing Address - Phone:708-261-4902
Mailing Address - Fax:
Practice Address - Street 1:1410 S RANDALL RD
Practice Address - Street 2:
Practice Address - City:ALGONQUIN
Practice Address - State:IL
Practice Address - Zip Code:60102-5919
Practice Address - Country:US
Practice Address - Phone:847-458-5796
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
U87013Medicare UPIN