Healthcare Provider Details

I. General information

NPI: 1790980589
Provider Name (Legal Business Name): AESTHETIC EYE ASSOCIATES S.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/20/2007
Last Update Date: 09/06/2023
Certification Date: 01/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 BIESTERFIELD RD STE 3006
ELK GROVE VILLAGE IL
60007-3364
US

IV. Provider business mailing address

619 FOREST AVE
WILMETTE IL
60091-1713
US

V. Phone/Fax

Practice location:
  • Phone: 877-898-3937
  • Fax: 847-283-7658
Mailing address:
  • Phone: 847-728-0105
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code207WX0200X
TaxonomyOphthalmic Plastic and Reconstructive Surgery Physician
License Number
License Number StateIL

VIII. Authorized Official

Name: KATHLEEN G ALBRECHT
Title or Position: OWNER
Credential:
Phone: 847-728-0105