MEDICARE: GERSTEIN EYE INSTITUTE

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	:	1578772349
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GERSTEIN EYE INSTITUTE

Provider Business Mailing Address
First Line	:	3042 W PETERSON AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60659-3729
Country	:	US
Telephone Number	:	773-973-3223
Fax Number	:	773-973-1119

Provider Business Practice Location Address
First Line	:	3042 W PETERSON AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60659-3729
Country	:	US
Telephone Number	:	773-973-3223
Fax Number	:	773-973-1119

Authorized Official
Title or Position	:	PRACTICE ADMINISTRATOR
Name	:	MRS. DANELLE L TORRES
Credential	:
Telephone Number	:	773-973-3223

Provider Enumeration Date	:	05/21/2007
Last Update Date	:	12/28/2021

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