=====================================================
General NPI Number Information
=====================================================
NPI Number | 1881908531
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HENRY I MEISELS, MD, SC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/04/2010
-----------------------------------------------------
Last Update Date | 08/04/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 800 AUSTIN ST SUITE 401W
-----------------------------------------------------
City | EVANSTON
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60202-3439
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 847-425-9400
-----------------------------------------------------
Fax | 847-425-9402
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 800 AUSTIN ST SUITE 401W
-----------------------------------------------------
City | EVANSTON
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60202-3439
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 847-425-9400
-----------------------------------------------------
Fax | 847-425-9402
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. HENRY ISAAC MEISELS
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 847-425-9400
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207W00000X
-----------------------------------------------------
Taxonomy Name | Ophthalmology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------