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General NPI Number Information
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NPI Number | 1669498267
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Entity Type | Organization
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Legal Business Name | KOVACH EYE INSTITUTE, LTD
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Dates
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Enumeration Date | 07/15/2006
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Last Update Date | 05/17/2018
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Provider Practice Location Address
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Address Line | 152 N ADDISON AVE
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City | ELMHURST
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State | IL
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Zip | 60126
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Country | US
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Telephone | 630-833-9621
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Fax | 630-833-9465
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Provider Business Mailing Address
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Address Line | 152 N ADDISON AVE
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City | ELMHURST
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State | IL
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Zip | 60126-2821
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Country | US
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Telephone | 630-833-9621
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Fax | 630-833-9465
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Authorized Official
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Title or Position | PRESIDENT
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Name | KEVIN J KOVACH
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Credential | C.O.E.
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Telephone | 630-833-9621
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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 | 042-616829
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License Number State | IL
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