Organization
FORZLEY EYE CLINIC LTD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SAMUEL JOSEPH FORZLEY (OWNER OPTOMETRIST)
(630) 243-2020
Entity
Organization
Contact information
Practice address
1192 WALTER ST, SUITE A, LEMONT, IL 60439-2905
(630) 243-2020
(630) 243-1100
Mailing address
1192 WALTER ST, SUITE A, LEMONT, IL 60439-2905
(630) 243-2020
(630) 243-1100
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0001621941
BLUE CROSS BLUE SHIELD IL
—
01
—
1207690001
DMERC REGION B
—
01
—
410042845
RAILROAD MEDICARE
—
Enumeration date
08/09/2006
Last updated
12/13/2007
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