MEDICARE: UNIVERSITY RETINA AND MACULA ASSOCIATES P C

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		IL

General Provider Information

NPI Number	:	1235124421
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UNIVERSITY RETINA AND MACULA ASSOCIATES P C

Provider Business Mailing Address
First Line	:	6320 159TH ST
Second Line	:	SUITE A
City	:	OAK FOREST
State	:	IL
Zip	:	60452-2776
Country	:	US
Telephone Number	:	708-687-2222
Fax Number	:	708-687-3829

Provider Business Practice Location Address
First Line	:	6320 159TH ST
Second Line	:	SUITE A
City	:	OAK FOREST
State	:	IL
Zip	:	60452-2776
Country	:	US
Telephone Number	:	708-687-2222
Fax Number	:	708-687-3829

Authorized Official
Title or Position	:	OWNER
Name	:	RAMA D JAGER
Credential	:	M.D.
Telephone Number	:	708-687-2222

Provider Enumeration Date	:	09/14/2005
Last Update Date	:	07/21/2022

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