MEDICARE: GUSTAVO TORRE

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	152W00000X	Optometrist	467141	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1023175536
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GUSTAVO TORRE

Provider Business Mailing Address
First Line	:	2425 N MILWAUKEE AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60647-2627
Country	:	US
Telephone Number	:	773-772-2020
Fax Number	:	773-772-3320

Provider Business Practice Location Address
First Line	:	2425 N MILWAUKEE AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60647-2627
Country	:	US
Telephone Number	:	773-772-2020
Fax Number	:	773-772-3320

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/03/2007
Last Update Date	:	07/07/2008

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Directions to “ GUSTAVO TORRE ” Practice Location

Language	Start Address	Practice Location

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