Provider Demographics
NPI:1144318403
Name:MIDWEST VISION CARE OF ILLINOIS LLC
Entity type:Organization
Organization Name:MIDWEST VISION CARE OF ILLINOIS LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RACHEL
Authorized Official - Middle Name:MARGARET
Authorized Official - Last Name:FOSTER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:618-281-2400
Mailing Address - Street 1:915 N. MAIN ST
Mailing Address - Street 2:STE 1
Mailing Address - City:COLUMBIA
Mailing Address - State:IL
Mailing Address - Zip Code:62236-1158
Mailing Address - Country:US
Mailing Address - Phone:618-281-2400
Mailing Address - Fax:618-281-2402
Practice Address - Street 1:915 N MAIN ST STE 1
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:IL
Practice Address - Zip Code:62236-1136
Practice Address - Country:US
Practice Address - Phone:618-281-2400
Practice Address - Fax:618-281-2402
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-11
Last Update Date:2021-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL203260Medicare PIN
ILF100132583Medicare PIN