Healthcare Provider Details

I. General information

NPI: 1730377011
Provider Name (Legal Business Name): FAGMAN EYE SURGERY ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/11/2007
Last Update Date: 10/11/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4711 GOLF RD SUITE 525
SKOKIE IL
60076-1224
US

IV. Provider business mailing address

4711 GOLF RD SUITE 525
SKOKIE IL
60076-1224
US

V. Phone/Fax

Practice location:
  • Phone: 847-675-2001
  • Fax: 847-675-2006
Mailing address:
  • Phone: 847-675-2001
  • Fax: 847-675-2006

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. WILLIAM SAMUEL FAGMAN
Title or Position: PHYSICIAN/OWNER
Credential: M.D.
Phone: 847-675-2001