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General NPI Number Information
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NPI Number | 1245636992
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Entity Type | Organization
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Legal Business Name | EYE PHYSICIANS OF ILLINOIS, SC
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Dates
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Enumeration Date | 11/07/2014
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Last Update Date | 11/07/2014
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Provider Practice Location Address
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Address Line | 419 S BRUNER ST
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City | HINSDALE
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State | IL
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Zip | 60521-3941
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Country | US
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Telephone | 630-525-1918
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Fax |
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Provider Business Mailing Address
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Address Line | 6785 WEAVER RD STE D
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City | ROCKFORD
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State | IL
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Zip | 61114-8055
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | HERBERT C BECKER JR.
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Credential | MD
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Telephone | 630-525-1918
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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 | 036097526
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License Number State | IL
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