Provider Demographics
NPI:1578238978
Name:ROSLEY EYECARE AND ASSOCIATES LLC
Entity type:Organization
Organization Name:ROSLEY EYECARE AND ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST/PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MAGDALENA
Authorized Official - Middle Name:LUCIA
Authorized Official - Last Name:BAK
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:773-343-0212
Mailing Address - Street 1:2300 LEHIGH AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:GLENVIEW
Mailing Address - State:IL
Mailing Address - Zip Code:60026-1692
Mailing Address - Country:US
Mailing Address - Phone:224-432-5147
Mailing Address - Fax:224-432-5167
Practice Address - Street 1:2300 LEHIGH AVE STE 100
Practice Address - Street 2:
Practice Address - City:GLENVIEW
Practice Address - State:IL
Practice Address - Zip Code:60026-1692
Practice Address - Country:US
Practice Address - Phone:224-432-5147
Practice Address - Fax:224-432-5167
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-09
Last Update Date:2022-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact ManagementGroup - Multi-Specialty
No152WP0200XEye and Vision Services ProvidersOptometristPediatricsGroup - Multi-Specialty
No152WV0400XEye and Vision Services ProvidersOptometristVision TherapyGroup - Multi-Specialty