Healthcare Provider Details

I. General information

NPI: 1427698489
Provider Name (Legal Business Name): DESEYE RETINA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/07/2020
Last Update Date: 02/17/2020
Certification Date: 02/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15905 S FREDERICK ST STE 105
PLAINFIELD IL
60586-2212
US

IV. Provider business mailing address

15905 S FREDERICK ST STE 105
PLAINFIELD IL
60586-2212
US

V. Phone/Fax

Practice location:
  • Phone: 815-714-9115
  • Fax:
Mailing address:
  • Phone: 815-714-9115
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QS0132X
TaxonomyOphthalmologic Surgery Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207WX0107X
TaxonomyRetina Specialist (Ophthalmology) Physician
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DR. ANKIT DESAI
Title or Position: PRESIDENT
Credential: MD
Phone: 815-714-9115