Organization
THIRD STREET EYECARE, LTD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RANDALL D BURGGRAF OD (DOCTOR)
(815) 751-5269
Entity
Organization
Contact information
Practice address
500 S THIRD ST, STE 105, GENEVA, IL 60134-2762
(815) 751-5269
(331) 248-0328
Mailing address
3317 HUSKING PEG LN, GENEVA, IL 60134-4656
(815) 751-5269
(331) 248-0328
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
00466713
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
046006713
—
IL
01
—
1447318563
INDIVIDUAL NPI
IL
Enumeration date
11/14/2011
Last updated
03/07/2023
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