Healthcare Provider Details

I. General information

NPI: 1205959053
Provider Name (Legal Business Name): COMPREHENSIVE EYECARE PHYSICIANS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/09/2007
Last Update Date: 10/16/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6233 W CERMAK RD
BERWYN IL
60402
US

IV. Provider business mailing address

1917 CHERRY LN
NORTHBROOK IL
60062
US

V. Phone/Fax

Practice location:
  • Phone: 708-749-2020
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number State

VIII. Authorized Official

Name: CECELIA GIBSON
Title or Position: OPHT. TECH
Credential:
Phone: 847-564-2020