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Organization

CRYSTAL CLEAR EYE CARE CLINIC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
SHERRY L BAKOVICH (OFFICE MANGER)
(847) 524-1700
Entity
Organization

Contact information

Practice address
1760 WISE, SCHAUMBERG, IL 60193
(847) 524-1700
(847) 524-1702
Mailing address
1760 WISE, SCHAUMBERG, IL 60193
(847) 524-1700
(847) 524-1702

Taxonomy

Speciality
Code
Description
License number
State
305R00000X
Preferred Provider Organization
Primary
046007080
IL
305R00000X
Preferred Provider Organization
047935456
IL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
1730125451
NPI
IL
01
1841370061
NPI
IL
Enumeration date
07/27/2009
Last updated
08/26/2010
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  • Eligibility checks
  • EDI platform