MEDICARE: DOCTORS FOR VISUAL FREEDOM INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207W00000X	Ophthalmology Physician

General Provider Information

NPI Number	:	1003835968
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DOCTORS FOR VISUAL FREEDOM INC

Provider Business Mailing Address
First Line	:	PO BOX 388320
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60638-8320
Country	:	US
Telephone Number	:	773-767-4600
Fax Number	:	773-767-8320

Provider Business Practice Location Address
First Line	:	5201 N HARLEM AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60656-1803
Country	:	US
Telephone Number	:	773-774-2102
Fax Number	:	773-774-3581

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MARK I GOLDEN
Credential	:	M.D.
Telephone Number	:	847-995-9944

Provider Enumeration Date	:	07/19/2006
Last Update Date	:	08/27/2009

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