MEDICARE: DR. BRIAN MICHAEL DOWLING O.D.

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	2757	CO
2	152W00000X	Optometrist	046-010310	IL

General Provider Information

NPI Number	:	1487886974
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRIAN MICHAEL DOWLING O.D.

Provider Business Mailing Address
First Line	:	2706 N MILWAUKEE AVE
Second Line	:	PEARLE VISION
City	:	CHICAGO
State	:	IL
Zip	:	60647-1308
Country	:	US
Telephone Number	:	773-862-5000
Fax Number	:	773-862-5059

Provider Business Practice Location Address
First Line	:	2706 N MILWAUKEE AVE
Second Line	:	PEARLE VISION
City	:	CHICAGO
State	:	IL
Zip	:	60647-1308
Country	:	US
Telephone Number	:	773-862-5000
Fax Number	:	773-862-5059

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

Provider Enumeration Date	:	08/17/2009
Last Update Date	:	06/11/2012

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