Organization
SUSAN M PENNER
Active
Other names
ELGIN FAMILY EYE CARE
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SUSAN M PENNER O.D. (OWNER)
(815) 734-6500
Entity
Organization
Contact information
Practice address
363 S RANDALL RD, ELGIN, IL 60123
(847) 888-1555
(847) 888-2508
Mailing address
363 S RANDALL RD, ELGIN, IL 60123
(847) 888-1555
(847) 888-2508
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0253870001
MEDICARE SUPPLIER
IL
01
—
0253870002
DMERC
IL
01
—
4515286
BCBS
IL
Enumeration date
05/02/2007
Last updated
05/20/2008
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