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Organization

LAKE BLUFF FAMILY EYE CARE, INC.

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. DAVID JACKSON O.D. (PRESIDENT)
(847) 735-1699
Entity
Organization

Contact information

Practice address
755 ROCKLAND ROAD, SUITE 201, LAKE BLUFF, IL 60044
(847) 735-1699
Mailing address
755 ROCKLAND ROAD, SUITE 201, LAKE BLUFF, IL 60044
(847) 735-1699

Taxonomy

Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
046008452
IL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
046008452
STATE OF ILLINOIS OPTOMETRIST PROFESSIONAL LICENSE
IL
Enumeration date
03/07/2013
Last updated
03/07/2013
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