MEDICARE: DR. FAKHOURY EYE CARE 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	261QM2500X	Medical Specialty Clinic/Center	046009416	IL

General Provider Information

NPI Number	:	1083090716
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DR. FAKHOURY EYE CARE PC

Provider Business Mailing Address
First Line	:	8362 GRAND AVE
Second Line	:
City	:	RIVER GROVE
State	:	IL
Zip	:	60171-1435
Country	:	US
Telephone Number	:	708-583-1100
Fax Number	:

Provider Business Practice Location Address
First Line	:	8362 GRAND AVE
Second Line	:
City	:	RIVER GROVE
State	:	IL
Zip	:	60171-1435
Country	:	US
Telephone Number	:	708-583-1100
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. NADER E. FAKHOURY
Credential	:	O.D.
Telephone Number	:	847-800-8856

Provider Enumeration Date	:	08/05/2015
Last Update Date	:	08/05/2015

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