Healthcare Provider Details

I. General information

NPI: 1174666432
Provider Name (Legal Business Name): WOHL EYE CENTER SC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/15/2007
Last Update Date: 11/04/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

303 E ARMY TRAIL RD
BLOOMINGDALE IL
60108-2169
US

IV. Provider business mailing address

303 E ARMY TRAIL RD
BLOOMINGDALE IL
60108-2169
US

V. Phone/Fax

Practice location:
  • Phone: 630-351-2030
  • Fax: 630-351-3983
Mailing address:
  • Phone: 630-351-2030
  • Fax: 630-351-3983

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number State

VIII. Authorized Official

Name: LISA WOHL
Title or Position: MEDICAL DIRECTOR
Credential: M.D.
Phone: 630-351-2030