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General NPI Number Information
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NPI Number | 1003835968
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Entity Type | Organization
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Legal Business Name | DOCTORS FOR VISUAL FREEDOM INC
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Dates
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Enumeration Date | 07/19/2006
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Last Update Date | 08/27/2009
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Provider Practice Location Address
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Address Line | 5201 N HARLEM AVE
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City | CHICAGO
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State | IL
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Zip | 60656-1803
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Country | US
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Telephone | 773-774-2102
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Fax | 773-774-3581
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Provider Business Mailing Address
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Address Line | PO BOX 388320
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City | CHICAGO
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State | IL
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Zip | 60638-8320
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Country | US
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Telephone | 773-767-4600
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Fax | 773-767-8320
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Authorized Official
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Title or Position | PRESIDENT
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Name | MARK I GOLDEN
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Credential | M.D.
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Telephone | 847-995-9944
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number |
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License Number State |
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