Healthcare Provider Details

I. General information

NPI: 1780723403
Provider Name (Legal Business Name): CHICAGO EYE INSTITUTE, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/06/2007
Last Update Date: 04/22/2021
Certification Date: 04/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5086 N ELSTON AVE
CHICAGO IL
60630-2427
US

IV. Provider business mailing address

5086 N ELSTON AVE
CHICAGO IL
60630-2427
US

V. Phone/Fax

Practice location:
  • Phone: 773-282-2000
  • Fax: 773-282-9428
Mailing address:
  • Phone: 773-282-2000
  • Fax: 773-282-9428

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MS. MICHELLE T VEREST
Title or Position: INSURANCE SUPERVISOR
Credential:
Phone: 773-282-2000