Healthcare Provider Details

I. General information

NPI: 1194726067
Provider Name (Legal Business Name): CHICAGO EYE CARE AND LASERS S C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/02/2005
Last Update Date: 05/15/2022
Certification Date: 05/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2252 S CANAL ST STE 201
CHICAGO IL
60616-1838
US

IV. Provider business mailing address

2252 S CANAL ST STE 201
CHICAGO IL
60616-1838
US

V. Phone/Fax

Practice location:
  • Phone: 312-225-5829
  • Fax: 312-225-5839
Mailing address:
  • Phone: 312-225-5829
  • Fax: 312-225-5839

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number036-107010
License Number StateIL

VIII. Authorized Official

Name: JINGTAO GUO
Title or Position: PRESIDENT
Credential:
Phone: 312-225-5829