Healthcare Provider Details

I. General information

NPI: 1376673863
Provider Name (Legal Business Name): EYE SPECIALISTS OF CHICAGO AND HIGHLAND PARK
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/06/2007
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5600 W ADDISON ST SUITE 102
CHICAGO IL
60634-4401
US

IV. Provider business mailing address

5600 W ADDISON ST SUITE 102
CHICAGO IL
60634-4401
US

V. Phone/Fax

Practice location:
  • Phone: 773-736-1717
  • Fax: 773-736-7538
Mailing address:
  • Phone: 773-736-1717
  • Fax: 773-736-7538

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StateIL

VIII. Authorized Official

Name: MRS. VALENTINA RUEHL
Title or Position: INSURANCE COORDINATOR
Credential:
Phone: 773-736-1717