MEDICARE: CHARLES OVITSKY

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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	CJ0861	OTHER	IL	RR MCR GROUP
2	0001604768	OTHER	IL	BLUE CROSS & BLUE SHIELD

General Provider Information

NPI Number	:	1821049693
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHARLES OVITSKY

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	:	PRESIDENT
Name	:	CHARLES S OVITSKY
Credential	:	O.D
Telephone Number	:	773-588-3090

Provider Enumeration Date	:	05/15/2006
Last Update Date	:	05/14/2008

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Directions to “CHARLES OVITSKY ” Practice Location

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