Healthcare Provider Details

I. General information

NPI: 1386736650
Provider Name (Legal Business Name): OAK PARK EYE CENTER S.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2006
Last Update Date: 10/04/2024
Certification Date: 10/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7638 W NORTH AVE
ELMWOOD PARK IL
60707-4157
US

IV. Provider business mailing address

7638 W NORTH AVE
ELMWOOD PARK IL
60707-4157
US

V. Phone/Fax

Practice location:
  • Phone: 708-452-4257
  • Fax: 708-452-4283
Mailing address:
  • Phone: 708-452-4257
  • Fax: 708-452-4283

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number007001910
License Number StateIL

VIII. Authorized Official

Name: DR. MICHAEL J HENNESSEY
Title or Position: PRESIDENT
Credential: MD
Phone: 708-452-4257