Organization
WANDERLUST EYECARE, P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. FAYE THERESE P. GAMBOA OD (PRESIDENT/OWNER)
(847) 787-1187
Entity
Organization
Contact information
Practice address
1745 ORCHARD LN, NORTHFIELD, IL 60093-3432
(847) 787-1187
(847) 789-7181
Mailing address
1745 ORCHARD LN, NORTHFIELD, IL 60093-3432
(847) 787-1187
(847) 789-7181
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
046010799
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1275948044
NPI TYPE 1
IL
Enumeration date
05/09/2018
Last updated
07/17/2019
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