Organization
GERIATRIC VISION CARE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JAMES NOTH (SECRETARY TREASURER)
(630) 655-0499
Entity
Organization
Contact information
Practice address
828 NORTH CASS AVE, SUITE 1B, WESTMONT, IL 60559
(312) 829-0956
(773) 904-7855
Mailing address
828 NORTH CASS AVENUE, SUITE 1B, WESTMONT, IL 60559
(312) 829-0956
(773) 904-7855
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
046009531
IL
207W00000X
Ophthalmology Physician
Primary
036062589
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
036062589
STATE OF ILLINOIS PA #
—
01
—
046009531
STATE OF ILLINOIS PA #
—
Enumeration date
10/26/2006
Last updated
10/23/2009
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