Healthcare Provider Details

I. General information

NPI: 1649323502
Provider Name (Legal Business Name): RITACCA LASER CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/22/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

230 CENTER DR
VERNON HILLS IL
60061-1584
US

IV. Provider business mailing address

230 CENTER DRIVE
VERNON HILLS IL
60061
US

V. Phone/Fax

Practice location:
  • Phone: 847-367-8815
  • Fax: 847-367-8819
Mailing address:
  • Phone: 847-367-8815
  • Fax: 847-367-8819

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number2086S0122X
License Number StateIL

VIII. Authorized Official

Name: DR. DANIEL J RITACCA
Title or Position: OPHTHALMOLOGIST
Credential: M.D
Phone: 847-367-8815