Eye Doc Inc

Primary specialty

OptometristTaxonomy code 152W00000X

License

046009552 Issued in IL

Legal business name

EYE DOC INC

Practice address

16020 Harlem Ave
Tinley Park, IL 60477-1612

Phone

(708) 614-6849

Fax

(708) 614-6864

NPI assigned

Nov 1, 2010

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Lisa Tung

Title

President

Phone

(708) 614-6849

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Lisa Tung OD Inc Former legal business name

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1288569600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1550102400000",
    "number": "1942500350",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16020 HARLEM AVE",
            "city": "TINLEY PARK",
            "state": "IL",
            "postal_code": "604771612",
            "telephone_number": "708-614-6849",
            "fax_number": "708-614-6864"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16020 HARLEM AVE",
            "city": "TINLEY PARK",
            "state": "IL",
            "postal_code": "604771612",
            "telephone_number": "708-614-6849",
            "fax_number": "708-614-6864"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EYE DOC INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-11-01",
        "last_updated": "2019-02-14",
        "status": "A",
        "authorized_official_last_name": "TUNG",
        "authorized_official_first_name": "LISA",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "708-614-6849",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "IL",
            "license": "046009552",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0460009552",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Lisa Tung OD Inc",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

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• Optometrist in Tinley Park, IL
• Providers in Tinley Park, IL by specialty
• Optometrist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 14, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.