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General NPI Number Information
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NPI Number | 1285685453
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Entity Type | Organization
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Legal Business Name | MIDWEST CENTER FOR VISION, SC
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Dates
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Enumeration Date | 05/13/2006
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Last Update Date | 10/12/2007
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Provider Practice Location Address
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Address Line | 1327 BUTTERFIELD RD SUITE 618
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City | DOWNERS GROVE
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State | IL
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Zip | 60515-1078
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Country | US
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Telephone | 630-776-7670
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Fax |
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Provider Business Mailing Address
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Address Line | 1327 BUTTERFIELD RD SUITE 618
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City | DOWNERS GROVE
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State | IL
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Zip | 60515-1078
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Country | US
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Telephone | 630-776-7670
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | CHARLES S AHN
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Credential | MD
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Telephone | 630-776-7670
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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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