NPI: 1669554572 · BOLINGBROOK, IL 60440 · 156FX1800X
| Year | Claims | Total Paid |
|---|---|---|
| 2019 | 20 | $400.00 |
| 2020 | 121 | $2K |
| 2022 | 299 | $8K |
| 2023 | 975 | $27K |
| 2024 | 881 | $26K |
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|---|---|---|---|
| V2020 | Vision svcs frames purchases | 1,152 | 1,112 | $40K |
| V2103 | Spherocylindr 4.00d/12-2.00d | 546 | 531 | $12K |
| V2100 | Lens spher single plano 4.00 | 246 | 246 | $5K |
| V2784 | Lens polycarb or equal | 296 | 296 | $4K |
| V2025 | Eyeglasses delux frames | 30 | 30 | $2K |
| V2104 | Spherocylindr 4.00d/2.12-4d | 26 | 26 | $518.00 |