Provider Demographics
NPI:1962973503
Name:SOLO EYE CARE BRIDGEPORT LLC
Entity type:Organization
Organization Name:SOLO EYE CARE BRIDGEPORT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JENIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:PANKOW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-704-1890
Mailing Address - Street 1:3460 S HALSTED ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60608-6743
Mailing Address - Country:US
Mailing Address - Phone:312-225-5135
Mailing Address - Fax:312-225-5309
Practice Address - Street 1:3460 S HALSTED ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60608-6743
Practice Address - Country:US
Practice Address - Phone:313-225-5135
Practice Address - Fax:312-225-5309
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-07
Last Update Date:2025-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact ManagementGroup - Multi-Specialty
No152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty