Healthcare Provider Details

I. General information

NPI: 1801811773
Provider Name (Legal Business Name): DUPAGE EYE SURGERY CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2015 N MAIN ST
WHEATON IL
60187-3152
US

IV. Provider business mailing address

2015 N MAIN ST
WHEATON IL
60187-3152
US

V. Phone/Fax

Practice location:
  • Phone: 630-665-3690
  • Fax: 630-665-3686
Mailing address:
  • Phone: 630-665-3690
  • Fax: 630-665-3686

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number StateIL

VIII. Authorized Official

Name: DR. CHARLES SANDOR
Title or Position: MEMBER
Credential: M.D.
Phone: 630-665-3690