Healthcare Provider Details

I. General information

NPI: 1063821916
Provider Name (Legal Business Name): NORTHWESTERN MEDICAL FACULTY FOUNDATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2014
Last Update Date: 01/17/2024
Certification Date: 01/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 N WESTMORELAND RD LOWER LEVEL 88
LAKE FOREST IL
60045-1674
US

IV. Provider business mailing address

5777 DEPT
CAROL STREAM IL
60122-4546
US

V. Phone/Fax

Practice location:
  • Phone: 847-295-0001
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code152WV0400X
TaxonomyVision Therapy Optometrist
License Number
License Number State

VIII. Authorized Official

Name: SABINA STRZEMINSKA
Title or Position: DIRECTOR
Credential:
Phone: 312-695-0646