Provider Demographics
NPI:1538242136
Name:IDEAL FAMILY EYE CARE LTD
Entity type:Organization
Organization Name:IDEAL FAMILY EYE CARE LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SYLWIA
Authorized Official - Middle Name:DOMINIKA
Authorized Official - Last Name:SZEWCZYK
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:773-206-0130
Mailing Address - Street 1:5526 N MILWAUKEE AVE
Mailing Address - Street 2:UNIT B
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60630-1227
Mailing Address - Country:US
Mailing Address - Phone:773-774-2200
Mailing Address - Fax:
Practice Address - Street 1:5526 N MILWAUKEE AVE
Practice Address - Street 2:UNIT B
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60630-1227
Practice Address - Country:US
Practice Address - Phone:773-774-2200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-24
Last Update Date:2008-01-03
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
IL214269Medicare PIN