Healthcare Provider Details

I. General information

NPI: 1538730668
Provider Name (Legal Business Name): THOMAS D PATRIANAKOS NORTHWEST CHICAGO EYE SPECIALISTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2021
Last Update Date: 10/29/2021
Certification Date: 10/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5872 N MILWAUKEE AVE
CHICAGO IL
60646-5425
US

IV. Provider business mailing address

5872 N MILWAUKEE AVE
CHICAGO IL
60646-5425
US

V. Phone/Fax

Practice location:
  • Phone: 773-792-2020
  • Fax:
Mailing address:
  • Phone: 773-792-2020
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number State

VIII. Authorized Official

Name: THOMAS PATRIANAKOS
Title or Position: OWNER
Credential: DO
Phone: 773-792-2020