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General NPI Number Information
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NPI Number | 1043225535
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Entity Type | Organization
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Legal Business Name | EYES OF GRACE SC
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Dates
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Enumeration Date | 07/31/2006
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Last Update Date | 11/12/2019
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Provider Practice Location Address
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Address Line | 9669 KENTON AVE STE 409
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City | SKOKIE
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State | IL
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Zip | 60076-1267
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Country | US
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Telephone | 847-933-0800
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Fax | 855-329-4224
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Provider Business Mailing Address
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Address Line | PO BOX 5178
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City | SKOKIE
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State | IL
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Zip | 60076-5178
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Country | US
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Telephone | 847-933-3555
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Fax | 847-933-3559
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Authorized Official
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Title or Position | PHYSICIAN
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Name | GRACE BAI
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Credential | MD
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Telephone | 847-933-0800
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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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