MEDICARE: CHARLES S OVITSKY 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	046007650	IL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	410022813	OTHER		RAILROAD MEDICARE
3	P01107046	OTHER		RAIL ROAD MEDICARE

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
4	0001604768	OTHER	IL	BLUE CROSS BLUE SHIELD
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1558313189
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHARLES S OVITSKY O.D

Provider Business Mailing Address
First Line	:	3500 W PETERSON AVE
Second Line	:	SUITE 401
City	:	CHICAGO
State	:	IL
Zip	:	60659-3306
Country	:	US
Telephone Number	:	773-588-3090
Fax Number	:	773-588-3210

Provider Business Practice Location Address
First Line	:	3500 W PETERSON AVE
Second Line	:	SUITE 401
City	:	CHICAGO
State	:	IL
Zip	:	60659-3306
Country	:	US
Telephone Number	:	773-588-3090
Fax Number	:	773-588-3210

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

Provider Enumeration Date	:	05/16/2006
Last Update Date	:	09/04/2018

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Directions to “ CHARLES S OVITSKY O.D” Practice Location

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