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General NPI Number Information
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NPI Number | 1578636825
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Entity Type | Organization
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Legal Business Name | NORTH SHORE EYE CENTER, INC.
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Dates
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Enumeration Date | 11/16/2006
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Last Update Date | 12/03/2007
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Provider Practice Location Address
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Address Line | 2914 CENTRAL ST
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City | EVANSTON
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State | IL
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Zip | 60201
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Country | US
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Telephone | 847-864-4768
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Fax |
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Provider Business Mailing Address
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Address Line | 2914 CENTRAL ST
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City | EVANSTON
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State | IL
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Zip | 60201-1237
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Country | US
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Telephone | 847-864-4768
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Fax | 847-864-4795
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Authorized Official
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Title or Position | PRESIDENT CEO
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Name | DR. MILLICENT L KNIGHT
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Credential | OD
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Telephone | 847-864-4768
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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 |
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License Number State | IL
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