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Myeyedr Optometry of Illinois, LLC

Organization Active NPI Optometrist · Bolingbrook, IL

NPI 1477055945 · NPPES record last updated May 26, 2022

Key facts

NPI
1477055945
Entity type
Organization (NPI type 2)
Primary specialty
Optometrist 152W00000X
Legal business name
MYEYEDR OPTOMETRY OF ILLINOIS, LLC
Practice address
310 S Weber Road
Bolingbrook, IL 60490
Phone
(630) 771-0600
Fax
(630) 759-9692
NPI assigned
Mar 1, 2018
Organization subpart
No

Authorized official

Name
Sue Healey
Title
Secretary
Phone
(703) 847-8899

Corporate family (same tax ID) 37

Organizations that report the same tax identification number in the National Provider Directory.

View all 37

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

Laboratory certificates & supplier records

Name & address match These CMS records do not include an NPI. They are shown here because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
14D2299681Myeyedr Optometry of Illinois, LLC
310 S Weber Rd, Bolingbrook, IL 60490		Certificate of waiverFeb 24, 2028

Medicare participation

Medicare fee-for-service enrollment
Enrolled in IL

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
O20160310001870 IL Part B Supplier - Clinic/Group Practice 3577869965 Receives reassigned benefits from 113 practitioners
This NPI is an additional NPI on the enrollment

National Provider Directory

Tax ID family
Myeyedr (38 organizations share this tax ID)

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist
Group: 193400000X SINGLE SPECIALTY GROUP		 152W00000X Yes

Addresses

Primary practice location

310 S Weber Road
Bolingbrook, IL 60490

Mailing address

8614 Westwood Center Dr FL 9
Vienna, VA 22182-2442
Phone (703) 847-8899

Other names

  • MyEyeDr. Doing business as

Other providers in Bolingbrook, IL

All providers in Bolingbrook, IL · Optometrist in Illinois

Sources for this page

Verify at the official NPI Registry.