Provider Demographics
NPI:1962883694
Name:IRISH EYES LLC
Entity type:Organization
Organization Name:IRISH EYES LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:KELLY
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:630-790-1300
Mailing Address - Street 1:489 TAFT AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:GLEN ELLYN
Mailing Address - State:IL
Mailing Address - Zip Code:60137-8209
Mailing Address - Country:US
Mailing Address - Phone:630-790-1300
Mailing Address - Fax:630-790-1378
Practice Address - Street 1:489 TAFT AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:GLEN ELLYN
Practice Address - State:IL
Practice Address - Zip Code:60137-8209
Practice Address - Country:US
Practice Address - Phone:630-790-1300
Practice Address - Fax:630-790-1378
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-18
Last Update Date:2015-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046-008415332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier