Organization
EYEDENTITY VISION CARE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. THOMAS J CARR O.D. (PRESIDENT)
(630) 232-4211
Entity
Organization
Contact information
Practice address
309 HAMILTON ST STE A, GENEVA, IL 60134-2182
(630) 232-4211
(630) 232-7636
Mailing address
309 HAMILTON ST STE A, GENEVA, IL 60134-2182
(630) 232-4211
(630) 232-7636
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
046-008336
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
04532377
BLUE CROSS BLUE SHIELD
IL
Enumeration date
08/07/2007
Last updated
12/16/2014
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