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General NPI Number Information
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NPI Number | 1366514176
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Entity Type | Individual
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Provider Name | EUGENE BERKOVICH O.D.
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Gender | Male
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Dates
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Enumeration Date | 11/15/2006
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Last Update Date | 03/25/2015
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Provider Practice Location Address
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Address Line | 6641 GRAND AVE SUITE D
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City | GURNEE
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State | IL
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Zip | 60031-5262
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Country | US
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Telephone | 847-856-1200
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Fax | 847-856-8527
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Provider Business Mailing Address
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Address Line | 6641 GRAND AVE SUITE D
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City | GURNEE
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State | IL
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Zip | 60031-5262
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Country | US
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Telephone | 847-856-1200
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Fax | 847-856-8527
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 46009457
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License Number State | IL
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