Healthcare Provider Details

I. General information

NPI: 1225224165
Provider Name (Legal Business Name): DEMPSTER EYE CARE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/24/2007
Last Update Date: 04/25/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5901 DEMPSTER ST SUITE 101
MORTON GROVE IL
60053-3014
US

IV. Provider business mailing address

5901 DEMPSTER ST SUITE 101
MORTON GROVE IL
60053-3014
US

V. Phone/Fax

Practice location:
  • Phone: 847-470-1115
  • Fax: 847-470-1141
Mailing address:
  • Phone: 847-470-1115
  • Fax: 847-470-1141

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number046-008065
License Number StateIL

VIII. Authorized Official

Name: DR. SUN AE MA
Title or Position: OPTOMETRIST
Credential: O.D.
Phone: 847-470-1115