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General NPI Number Information
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NPI Number | 1821049693
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Entity Type | Organization
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Legal Business Name | CHARLES OVITSKY
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Dates
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Enumeration Date | 05/15/2006
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Last Update Date | 05/14/2008
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Provider Practice Location Address
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Address Line | 3500 W PETERSON AVE SUITE 401
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City | CHICAGO
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State | IL
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Zip | 60659-3306
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Country | US
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Telephone | 773-588-3090
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Fax | 773-588-3210
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Provider Business Mailing Address
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Address Line | 3500 W PETERSON AVE SUITE 401
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City | CHICAGO
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State | IL
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Zip | 60659-3306
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Country | US
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Telephone | 773-588-3090
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Fax | 773-588-3210
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Authorized Official
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Title or Position | PRESIDENT
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Name | CHARLES S OVITSKY
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Credential | O.D
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Telephone | 773-588-3090
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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 | 046007650
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License Number State | IL
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