Provider Demographics
NPI:1902156896
Name:ARTISTIC EYE, LLC
Entity Type:Organization
Organization Name:ARTISTIC EYE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BEVERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:WOLTMAN
Authorized Official - Suffix:
Authorized Official - Credentials:BCO
Authorized Official - Phone:630-914-4144
Mailing Address - Street 1:573 CAMBRIDGE WAY
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-1047
Mailing Address - Country:US
Mailing Address - Phone:630-914-4144
Mailing Address - Fax:
Practice Address - Street 1:6800 S. MAIN STREET
Practice Address - Street 2:SUITE LL-5
Practice Address - City:DOWNERS GROVE
Practice Address - State:IL
Practice Address - Zip Code:60516-3593
Practice Address - Country:US
Practice Address - Phone:630-985-5008
Practice Address - Fax:630-981-0458
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-18
Last Update Date:2023-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0631512156FX1700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1700XEye and Vision Services ProvidersTechnician/TechnologistOcularistGroup - Single Specialty