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General NPI Number Information
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NPI Number | 1649323502
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Entity Type | Organization
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Legal Business Name | RITACCA LASER CENTER
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Dates
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Enumeration Date | 01/22/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 230 CENTER DR
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City | VERNON HILLS
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State | IL
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Zip | 60061-1584
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Country | US
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Telephone | 847-367-8815
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Fax | 847-367-8819
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Provider Business Mailing Address
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Address Line | 230 CENTER DRIVE
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City | VERNON HILLS
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State | IL
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Zip | 60061
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Country | US
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Telephone | 847-367-8815
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Fax | 847-367-8819
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Authorized Official
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Title or Position | OPHTHALMOLOGIST
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Name | DR. DANIEL J RITACCA
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Credential | M.D
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Telephone | 847-367-8815
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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 | 2086S0122X
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License Number State | IL
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