Healthcare Provider Details

I. General information

NPI: 1831377282
Provider Name (Legal Business Name): OPHTHALMIC RESOURCES GROUP, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/07/2008
Last Update Date: 02/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2640 183RD ST
HOMEWOOD IL
60430-2914
US

IV. Provider business mailing address

2640 183RD ST
HOMEWOOD IL
60430-2914
US

V. Phone/Fax

Practice location:
  • Phone: 708-798-6633
  • Fax: 708-798-6790
Mailing address:
  • Phone: 708-798-6633
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number StateIL

VIII. Authorized Official

Name: DR. DAVID M LUBECK
Title or Position: OWNER
Credential: M.D.
Phone: 708-798-6633