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General NPI Number Information
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NPI Number | 1740380336
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Entity Type | Organization
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Legal Business Name | OPHTHALMIC SPECIALISTS GROUP, LLC
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Dates
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Enumeration Date | 09/23/2006
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Last Update Date | 05/23/2012
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Provider Practice Location Address
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Address Line | 18440 GOVERNORS HWY
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City | HOMEWOOD
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State | IL
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Zip | 60430-2911
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Country | US
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Telephone | 708-798-2191
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Fax |
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Provider Business Mailing Address
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Address Line | 18440 GOVERNORS HWY
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City | HOMEWOOD
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State | IL
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Zip | 60430-2911
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Country | US
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Telephone | 708-798-2191
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Fax |
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | RACHEL GENA
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Credential |
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Telephone | 708-798-2191
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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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