=====================================================
General NPI Number Information
=====================================================
NPI Number | 1003099870
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | STEPHEN A. VILE MD SC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/14/2007
-----------------------------------------------------
Last Update Date | 08/06/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 940 LEE ST
-----------------------------------------------------
City | DES PLAINES
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60016-6555
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 847-299-5501
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 940 LEE ST
-----------------------------------------------------
City | DES PLAINES
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60016-6555
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | STEPHEN A. VILE MD SC
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 847-299-5501
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207W00000X
-----------------------------------------------------
Taxonomy Name | Ophthalmology Physician
-----------------------------------------------------
License Number | 042001978
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------