=====================================================
General NPI Number Information
=====================================================
NPI Number | 1629185376
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GARY FINKELSTEIN MD EYE ASSOCIATES SC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/25/2006
-----------------------------------------------------
Last Update Date | 05/24/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 102 WEST ELM STREET
-----------------------------------------------------
City | STREATOR
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 61364
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 815-672-4600
-----------------------------------------------------
Fax | 815-672-3333
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 102 WEST ELM STREET
-----------------------------------------------------
City | STREATOR
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 61364
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 815-672-4600
-----------------------------------------------------
Fax | 815-672-3333
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PARTNER
-----------------------------------------------------
Name | DR. GARY RICHARD FINKELSTEIN
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 815-672-4600
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207W00000X
-----------------------------------------------------
Taxonomy Name | Ophthalmology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------