Healthcare Provider Details

I. General information

NPI: 1205957149
Provider Name (Legal Business Name): DOLTON OPTOMETRIC CENTER, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/02/2007
Last Update Date: 02/11/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14223 CHICAGO RD
DOLTON IL
60419-1203
US

IV. Provider business mailing address

14223 CHICAGO RD
DOLTON IL
60419-1203
US

V. Phone/Fax

Practice location:
  • Phone: 708-849-0690
  • Fax: 708-849-0344
Mailing address:
  • Phone: 708-849-0690
  • Fax: 708-849-0344

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number046-0074685
License Number StateIL

VIII. Authorized Official

Name: DR. JAMES B LEVINSON
Title or Position: PRESIDENT
Credential: O.D., F.A.A.O.
Phone: 708-849-0690