Provider Demographics
NPI:1871692863
Name:LAKEVIEW EYECARE CENTER LTD
Entity type:Organization
Organization Name:LAKEVIEW EYECARE CENTER LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:WEILER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:773-327-0874
Mailing Address - Street 1:3500 N ASHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-1314
Mailing Address - Country:US
Mailing Address - Phone:773-327-0874
Mailing Address - Fax:773-327-6535
Practice Address - Street 1:3500 N ASHLAND AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-1314
Practice Address - Country:US
Practice Address - Phone:773-327-0874
Practice Address - Fax:773-327-6535
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-22
Last Update Date:2008-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046.008449152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1871692863Medicare NSC
IL0762480001Medicare NSC
IL1699755751Medicare NSC
IL213216Medicare ID - Type Unspecified