Healthcare Provider Details

I. General information

NPI: 1821944877
Provider Name (Legal Business Name): TUMMY VISION LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/10/2026
Last Update Date: 03/10/2026
Certification Date: 03/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

344 HARRISON ST
OAK PARK IL
60304-1587
US

IV. Provider business mailing address

6037 S NORMANDY AVE
CHICAGO IL
60638-4119
US

V. Phone/Fax

Practice location:
  • Phone: 833-338-8669
  • Fax:
Mailing address:
  • Phone: 833-338-8669
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085U0001X
TaxonomyDiagnostic Ultrasound Physician
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL PAUL STAESCHE
Title or Position: OWNER
Credential:
Phone: 773-706-2637