Healthcare Provider Details

I. General information

NPI: 1548275985
Provider Name (Legal Business Name): LAKESHORE EYE PHYSICIANS AND SURGEONS SC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/31/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7200 NORTH WESTERN AVENUE
CHICAGO IL
60645-1812
US

IV. Provider business mailing address

7080 NORTH WESTERN AVENUE
CHICAGO IL
60645
US

V. Phone/Fax

Practice location:
  • Phone: 773-743-6700
  • Fax: 773-761-9226
Mailing address:
  • Phone: 773-465-7777
  • Fax: 773-761-9226

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: HOWARD JOEL REINGLASS
Title or Position: PRESIDENT
Credential: MD
Phone: 773-743-6700