Healthcare Provider Details

I. General information

NPI: 1013085992
Provider Name (Legal Business Name): RETINA CONSULTANTS, LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/01/2006
Last Update Date: 11/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2454 E DEMPSTER ST 400
DES PLAINES IL
60016-5315
US

IV. Provider business mailing address

2454 E DEMPSTER ST 400
DES PLAINES IL
60016-5315
US

V. Phone/Fax

Practice location:
  • Phone: 847-299-0700
  • Fax:
Mailing address:
  • Phone: 847-299-0700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: MS. GINGER ESCHEVERRIA
Title or Position: PRACTICE ADMINISTRATOR
Credential:
Phone: 847-299-0700