Healthcare Provider Details

I. General information

NPI: 1730977117
Provider Name (Legal Business Name): PAIGE PLINE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/28/2025
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1849 GREEN BAY RD STE 165
HIGHLAND PARK IL
60035-3165
US

IV. Provider business mailing address

555 W MADISON ST APT 3606
CHICAGO IL
60661-2667
US

V. Phone/Fax

Practice location:
  • Phone: 847-780-3806
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number046.012143
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPT.007381
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: