Provider Demographics
NPI:1588730055
Name:VISION SOURCE TINLEY PARK SERIES
Entity type:Organization
Organization Name:VISION SOURCE TINLEY PARK SERIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:RIMKUS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:708-532-3450
Mailing Address - Street 1:17049 HARLEM AVE
Mailing Address - Street 2:
Mailing Address - City:TINLEY PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60477-2739
Mailing Address - Country:US
Mailing Address - Phone:708-532-3450
Mailing Address - Fax:708-532-9478
Practice Address - Street 1:17049 HARLEM AVE
Practice Address - Street 2:
Practice Address - City:TINLEY PARK
Practice Address - State:IL
Practice Address - Zip Code:60477-2739
Practice Address - Country:US
Practice Address - Phone:708-532-3450
Practice Address - Fax:708-532-9478
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-28
Last Update Date:2013-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILIL7610Medicare PIN