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Contact Information

BOLINGBROOK VISION SOURCE INC.
492 W BOUGHTON RD
BOLINGBROOK, IL60440-1441
 Phone: 630-759-4396
 Fax: 630-759-7761
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Optometrist

152W00000X 41 Optometry
Indicates primary specialty

NPI Profile & details for BOLINGBROOK VISION SOURCE INC.

NPI Number 1902129604
LBN Legal business name BOLINGBROOK VISION SOURCE INC.
Authorized official JOHN GARDNER - (OWNER)
Entity Organization
Organization subpart 1 No
Enumeration date 03/09/2010
Last updated 03/09/2010 - About 16 years ago
Identifiers
IL License # 046006455
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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