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General NPI Number Information
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NPI Number | 1194726067
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Entity Type | Organization
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Legal Business Name | CHICAGO EYE CARE AND LASERS S C
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Dates
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Enumeration Date | 08/02/2005
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Last Update Date | 05/15/2022
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Provider Practice Location Address
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Address Line | 2252 S CANAL ST STE 201
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City | CHICAGO
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State | IL
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Zip | 60616-1838
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Country | US
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Telephone | 312-225-5829
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Fax | 312-225-5839
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Provider Business Mailing Address
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Address Line | 2252 S CANAL ST STE 201
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City | CHICAGO
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State | IL
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Zip | 60616-1838
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Country | US
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Telephone | 312-225-5829
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Fax | 312-225-5839
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Authorized Official
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Title or Position | PRESIDENT
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Name | JINGTAO GUO
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Credential |
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Telephone | 312-225-5829
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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 | 036-107010
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License Number State | IL
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