Provider Demographics
NPI:1538200597
Name:KRESCA EYE CLINIC,LTD
Entity type:Organization
Organization Name:KRESCA EYE CLINIC,LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:DR
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:KRESCA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:630-893-8980
Mailing Address - Street 1:975 E NERGE RD
Mailing Address - Street 2:SUITE N110
Mailing Address - City:ROSELLE
Mailing Address - State:IL
Mailing Address - Zip Code:60172-4804
Mailing Address - Country:US
Mailing Address - Phone:630-893-8980
Mailing Address - Fax:
Practice Address - Street 1:975 E NERGE RD
Practice Address - Street 2:SUITE N110
Practice Address - City:ROSELLE
Practice Address - State:IL
Practice Address - Zip Code:60172-4804
Practice Address - Country:US
Practice Address - Phone:630-893-8980
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL675800Medicare ID - Type Unspecified