MEDICARE: PEDIATRIC EYE CONSULTANTS PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207W00000X	Ophthalmology Physician		IL

General Provider Information

NPI Number	:	1063541530
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PEDIATRIC EYE CONSULTANTS PC

Provider Business Mailing Address
First Line	:	3541 W IRVING PARK RD
Second Line	:	BLDG 1E
City	:	CHICAGO
State	:	IL
Zip	:	60618-3219
Country	:	US
Telephone Number	:	773-478-1600
Fax Number	:	773-478-2600

Provider Business Practice Location Address
First Line	:	3541 W IRVING PARK RD
Second Line	:	BLDG 1E
City	:	CHICAGO
State	:	IL
Zip	:	60618-3219
Country	:	US
Telephone Number	:	773-478-1600
Fax Number	:	773-478-2600

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. GREGORY JOSEPH PACELLI
Credential	:	MD, PHD
Telephone Number	:	773-478-1600

Provider Enumeration Date	:	03/02/2007
Last Update Date	:	08/22/2020

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