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General NPI Number Information
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NPI Number | 1063541530
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Entity Type | Organization
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Legal Business Name | PEDIATRIC EYE CONSULTANTS PC
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Dates
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Enumeration Date | 03/02/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 3541 W IRVING PARK RD BLDG 1E
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City | CHICAGO
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State | IL
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Zip | 60618-3219
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Country | US
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Telephone | 773-478-1600
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Fax | 773-478-2600
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Provider Business Mailing Address
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Address Line | 3541 W IRVING PARK RD BLDG 1E
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City | CHICAGO
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State | IL
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Zip | 60618-3219
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Country | US
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Telephone | 773-478-1600
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Fax | 773-478-2600
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. GREGORY JOSEPH PACELLI
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Credential | MD, PHD
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Telephone | 773-478-1600
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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 | IL
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