Healthcare Provider Details

I. General information

NPI: 1992698203
Provider Name (Legal Business Name): GERSTEIN IOR LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/03/2025
Last Update Date: 07/17/2025
Certification Date: 07/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3042 W PETERSON AVE
CHICAGO IL
60659-3729
US

IV. Provider business mailing address

3042 W PETERSON AVE
CHICAGO IL
60659-3729
US

V. Phone/Fax

Practice location:
  • Phone: 773-973-3223
  • Fax:
Mailing address:
  • Phone: 773-973-3223
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QS0132X
TaxonomyOphthalmologic Surgery Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: CRAIG GERSTEIN
Title or Position: MEDICAL DIRECTOR
Credential:
Phone: 773-973-3223