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General NPI Number Information
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NPI Number | 1952793739
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Entity Type | Organization
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Legal Business Name | RETINA CARE, LLC
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Dates
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Enumeration Date | 03/03/2015
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Last Update Date | 03/03/2015
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Provider Practice Location Address
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Address Line | 4709 GOLF RD SUITE 117
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City | SKOKIE
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State | IL
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Zip | 60076-1231
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Country | US
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Telephone | 847-423-2077
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Fax | 847-423-2959
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Provider Business Mailing Address
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Address Line | 4709 GOLF RD SUITE 117
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City | SKOKIE
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State | IL
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Zip | 60076-1231
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Country | US
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Telephone | 847-423-2077
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Fax | 847-423-2959
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Authorized Official
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Title or Position | BILLNG MANAGER
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Name | MS. LOURDES VALENTINE
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Credential |
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Telephone | 847-423-2077
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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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