Healthcare Provider Details

I. General information

NPI: 1073614863
Provider Name (Legal Business Name): EVANSTON OPHTHALMOLOGISTS, S.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4709 GOLF RD TWELFTH FLOOR
SKOKIE IL
60076-1231
US

IV. Provider business mailing address

4709 GOLF RD TWELFTH FLOOR
SKOKIE IL
60076-1231
US

V. Phone/Fax

Practice location:
  • Phone: 847-328-2020
  • Fax: 847-328-0523
Mailing address:
  • Phone: 847-328-2020
  • Fax: 847-328-0523

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number36059607
License Number StateIL

VIII. Authorized Official

Name: DR. WILLIAM G MYERS
Title or Position: PARTNER
Credential: M.D.
Phone: 847-328-2020