Advanced Eyecare of Hanover Park, Corp.
Organization Active NPI Optometrist · Hanover Park, IL
NPI 1790486207 · NPPES record last updated Feb 21, 2024
Key facts
- NPI
- 1790486207
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Optometrist 152W00000X
- Legal business name
- ADVANCED EYECARE OF HANOVER PARK, CORP.
- Practice address
- 1156 E Lake St
Hanover Park, IL 60133-5421 - Phone
- (630) 855-5542
- NPI assigned
- Mar 13, 2023
- Organization subpart
- No
Authorized official
- Name
- Grishma P Patel
- Title
- Owner
- Phone
- (630) 855-5542
Practitioners 2
-
Grishma Premal Patel, O.D.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IL
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20230613001318 | IL | Part B Supplier - Clinic/Group Practice | 9537526173 |
Receives reassigned benefits from 2 practitioners Practice locations: Hanover Park, IL |
National Provider Directory
Locations
1156 E Lake St
Hanover Park, IL 60133
Phone (630) 855-5542
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist |
152W00000X | Yes |
Addresses
Primary practice location
1156 E Lake St
Hanover Park, IL 60133-5421
Mailing address
1325 N Main St
Wheaton, IL 60187-3579
Phone (630) 668-4144
Other names
- Advanced Eyecare of Hanover Park
Other providers in Hanover Park, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 21, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.