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General NPI Number Information
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NPI Number | 1417037623
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Entity Type | Organization
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Legal Business Name | RETINA INSTITUTE OF ILLINOIS PC
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Dates
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Enumeration Date | 10/16/2006
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Last Update Date | 06/18/2025
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Provider Practice Location Address
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Address Line | 8780 W GOLF RD SUITE 304
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City | NILES
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State | IL
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Zip | 60714-5602
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Country | US
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Telephone | 847-297-8900
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Fax | 847-297-8926
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Provider Business Mailing Address
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Address Line | 8780 W GOLF RD SUITE 304
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City | NILES
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State | IL
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Zip | 60714-5602
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Country | US
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Telephone | 847-297-8900
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Fax | 847-297-8926
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Authorized Official
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Title or Position | CHIEF REVENUE CYCLE OFFICER
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Name | CANDICE B DAVIS
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Credential |
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Telephone | 916-990-7590
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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 |
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