Healthcare Provider Details

I. General information

NPI: 1720283195
Provider Name (Legal Business Name): GERSTEIN EYE INSTITUTE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/18/2007
Last Update Date: 12/28/2021
Certification Date: 12/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3042 WEST PETERSON AVE
CHICAGO IL
60659
US

IV. Provider business mailing address

3042 WEST PETERSON AVE
CHICAGO IL
60659
US

V. Phone/Fax

Practice location:
  • Phone: 773-973-3223
  • Fax: 773-973-1119
Mailing address:
  • Phone: 773-973-3223
  • Fax: 773-973-1119

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number State

VIII. Authorized Official

Name: DANELLE TORRES
Title or Position: PRACTICE ADMINISTRATOR
Credential:
Phone: 773-973-3223