Healthcare Provider Details

I. General information

NPI: 1326179557
Provider Name (Legal Business Name): ERTMAN EYE GROUP, LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/08/2007
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4650 W. NORTH AVE.
CHICAGO IL
60639
US

IV. Provider business mailing address

4650 W. NORTH AVE.
CHICAGO IL
60639
US

V. Phone/Fax

Practice location:
  • Phone: 773-252-8152
  • Fax: 773-252-8278
Mailing address:
  • Phone: 773-252-8152
  • Fax: 773-252-8278

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number StateIL

VIII. Authorized Official

Name: DR. EUGENE ERTMAN
Title or Position: PRESIDENT
Credential: OD
Phone: 773-252-8152