Provider Demographics
NPI:1700927597
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 1:2011 ROUND BARN RD
Mailing Address - Street 2:
Mailing Address - City:CHAMPAIGN
Mailing Address - State:IL
Mailing Address - Zip Code:61821-6825
Mailing Address - Country:US
Mailing Address - Phone:217-356-2557
Mailing Address - Fax:
Practice Address - Street 1:2011 ROUND BARN RD
Practice Address - Street 2:
Practice Address - City:CHAMPAIGN
Practice Address - State:IL
Practice Address - Zip Code:61821-6825
Practice Address - Country:US
Practice Address - Phone:217-356-2557
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-12
Last Update Date:2008-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL060.000856207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL671240Medicare ID - Type Unspecified