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General NPI Number Information
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NPI Number | 1902771199
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Entity Type | Organization
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Legal Business Name | ICU HERE PC
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Dates
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Enumeration Date | 10/07/2025
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Last Update Date | 10/07/2025
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Provider Practice Location Address
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Address Line | 657 W BELDEN AVE
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City | ELMHURST
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State | IL
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Zip | 60126-1869
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Country | US
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Telephone | 630-853-6969
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Fax | 773-346-1331
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Provider Business Mailing Address
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Address Line | 657 W BELDEN AVE
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City | ELMHURST
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State | IL
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Zip | 60126-1869
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Country | US
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Telephone | 630-853-6969
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Fax | 773-346-1331
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Authorized Official
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Title or Position | CEO
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Name | JASON H. GREENBERG
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Credential | OD
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Telephone | 630-853-6969
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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 |
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License Number State |
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