Provider Demographics
NPI:1871206706
Name:FAMILY EYECARE ALEXIS E SCATCHELL OD
Entity type:Organization
Organization Name:FAMILY EYECARE ALEXIS E SCATCHELL OD
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:ALEXANDRIA
Authorized Official - Middle Name:E
Authorized Official - Last Name:SCATCHELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-458-3230
Mailing Address - Street 1:5316 N MILWAUKEE AVE # 2C
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60630-1269
Mailing Address - Country:US
Mailing Address - Phone:708-831-4564
Mailing Address - Fax:708-831-4567
Practice Address - Street 1:5316 N MILWAUKEE AVE # 2C
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60630-1269
Practice Address - Country:US
Practice Address - Phone:708-831-4564
Practice Address - Fax:708-831-4567
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-05
Last Update Date:2023-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL046009919Medicaid