| Illiana Eyecare Inc | |
|
13115 Wicker Avenue, Suite E, Cedar Lake, IN 46303 | |
| (219) 374-7800 | |
| Not Available |
| Full Name | Illiana Eyecare Inc |
|---|---|
| Type | Facility |
| Speciality | Optometrist |
| Location | 13115 Wicker Avenue, Cedar Lake, Indiana |
| Accepts Medicare Assignments | Medicare enrolled and accepts medicare insurance. Providers at this facility may prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1215040142 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 152W00000X | Optometrist | 046009654 (Indiana) | Primary |
| Provider Name | Jill S Davids |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1023078961 PECOS PAC ID: 3870554058 Enrollment ID: I20070328000615 |
| Provider Name | Melissa Dawn Bourland |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1346766060 PECOS PAC ID: 1951674514 Enrollment ID: I20170901000078 |
| Provider Name | Brittany R Disterheft |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1760906135 PECOS PAC ID: 2769738871 Enrollment ID: I20180703001238 |
| Provider Name | Kaitlyn Renae Gibson |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1992319719 PECOS PAC ID: 2365852464 Enrollment ID: I20201030001346 |
| Mailing Address | Practice Location Address |
|---|---|
| Illiana Eyecare Inc 13115 Wicker Avenue, Suite E, Cedar Lake, IN 46303 Ph: (219) 374-7800 | Illiana Eyecare Inc 13115 Wicker Avenue, Suite E, Cedar Lake, IN 46303 Ph: (219) 374-7800 |
Kossis Eyecare Llc Optometrist Medicare: Not Enrolled in Medicare Practice Location: 9849 Lincoln Plaza Way, Cedar Lake, IN 46303 Phone: 216-789-9066 | |
Mrs. Brittany Rae Disterheft, OD Optometrist Medicare: Accepting Medicare Assignments Practice Location: 13115 Wicker Ave Ste E, Cedar Lake, IN 46303 Phone: 219-374-7800 Fax: 219-374-5196 | |
Dr. Kaitlyn Renae Gibson, OD Optometrist Medicare: Accepting Medicare Assignments Practice Location: 13115 Wicker Ave Ste E, Cedar Lake, IN 46303 Phone: 219-374-7800 Fax: 219-374-5196 |