| Organization Name: | KERATOCONUS SPECIALIST OF ILLINOIS LTD |
| NPI Number: | 1043648439 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | STEVEN B EIDEN (OWNER/MEDICAL DIRECTOR) |
| Mailing Address: | 4 Westbrook Corporate Ctr Suite 111 Westchester |
| State: | IL US |
| Postal Code: | 601545752 |
| Phone Number: | 7085624682 |
| Fax Number: | 7085624785 |
| NPI Enumeration Date: | 10/22/2013 |
| NPI Last Update Date: | 10/22/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 152WC0802X |
| License Number: | 046007419 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | IL |
| Taxonomy Type: | Eye and Vision Services Providers |
| Taxonomy Classification: | Optometrist |
| Taxonomy Specialization: | Corneal and Contact Management |
| Taxonomy Definition: | The professional activities performed by an Optometrist related to the fitting of contact lenses to an eye, ongoing evaluation of the cornea |