Healthcare Provider Details

I. General information

NPI: 1972794451
Provider Name (Legal Business Name): GOREN EYE ASSOCIATES, SC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/08/2007
Last Update Date: 08/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

180 N STETSON AVE SUITE 3175
CHICAGO IL
60601-6710
US

IV. Provider business mailing address

180 N STETSON AVE SUITE 3175
CHICAGO IL
60601-6710
US

V. Phone/Fax

Practice location:
  • Phone: 312-332-2262
  • Fax:
Mailing address:
  • Phone: 312-332-2262
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. MATTHEW BRENT GOREN
Title or Position: PRESIDENT
Credential: MD
Phone: 312-332-2262