Healthcare Provider Details

I. General information

NPI: 1568451086
Provider Name (Legal Business Name): ROBERT PANTON
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/18/2005
Last Update Date: 03/23/2021
Certification Date: 03/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7740 W NORTH AVE
ELMWOOD PARK IL
60707
US

IV. Provider business mailing address

7740 W NORTH AVE
ELMWOOD PARK IL
60707-4116
US

V. Phone/Fax

Practice location:
  • Phone: 708-452-7200
  • Fax:
Mailing address:
  • Phone: 708-452-2000
  • Fax: 708-452-5777

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number036077280
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: