Organization
BRENART EYE CLINIC, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. MARY E MELICK COA, OCS (OFFICE MANAGER)
(630) 553-6166
Entity
Organization
Contact information
Practice address
120 E COUNTRYSIDE PKWY, YORKVILLE, IL 60560-1877
(630) 553-6166
(630) 553-6178
Mailing address
120 E COUNTRYSIDE PKWY, YORKVILLE, IL 60560-1877
(630) 553-6166
(630) 553-6178
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
046006926
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
046006926
—
IL
05
—
046008133
—
IL
05
—
046008147
—
IL
05
—
046009086
—
IL
05
—
046009279
—
IL
01
—
046010275
LICENSE
IL
Enumeration date
11/29/2006
Last updated
08/11/2010
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