MEDICARE: THE EYE SPECIALISTS CENTER LLC

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

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
4	180046208	OTHER	IL	MEDICARE RAILROAD
5	205786	OTHER	IL	PTAN IL MEDICARE DUPAGE COUNTY
6	CK7818	OTHER	IL	MEDICARE RAILROAD GRP PTAN
10	PTAN P00638025	OTHER	IL	RAILROAD MEDICARE
14	P00638025	OTHER	IL	MEDICARE RAILROAD
19	205785	OTHER	IL	PTAN IL MEDICARE COOK COUNTY
27	180046211	OTHER	IL	MEDICARE RAILROAD
34	180046209	OTHER	IL	MEDICARE RAILROAD
35	180046210	OTHER	IL	MEDICARE RAILROAD
36	180046212	OTHER	IL	MEDICARE RAILROAD
40	253350	OTHER	IN	PTAN INDIANA MEDICARE GROUP

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1659412682	OTHER	IL	NPI IDIVIDUAL HASSAN SHAH, MD
2	1679551014	OTHER	IL	NPI INDIVIDUAL
3	1770544462	OTHER	IL	NPI INDIVIDUAL EMMET M. CASSIDY, MD
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
8	1649256512	OTHER	IL	NPI INDIVIDUAL ALEXANDER J KHAMMAR, MD
9	1689988446	OTHER	IL	NPI INDIVIDUAL CHRISTINA M TWARDOWSKI, OD
11	036128553	OTHER	IL	PHYSICIANS LICENSE
12	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
13	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
15	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
16	1386637791	OTHER	IL	INDIVIDUAL NPI
17	1992782494	OTHER	IL	NPI INDIVIDUAL BENJAMIN H TICHO
18	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
20	01620861	OTHER	IL	BLUE CROSS AND BLUE SHEILD OF ILLINOIS
21	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
22	046009799	OTHER	IL	LICENSE NO
23	1477522050	OTHER	IL	NPI INDIVIDUAL JONATHAN S BUKA, MD
24	1699802421	OTHER	IL	OPTICAL NPI THE EYE SPECIALISTS CENTER
25	1700047222	OTHER	IL	NPI DR SHIFRIN
26	1700047222	OTHER	IN	NPI INDIVIDUAL KABITA S SHIFRIN, DO
28	12324832	OTHER	IL	CAQH R. VASAIWALA, MD
29	1477522050	OTHER	IN	NPI INDIVIDUAL JONATHAN S BUKA, MD
30	1649256512	OTHER	IN	NPI INDIVIDUAL ALEXANDER J KHAMMAR, MD
31	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
32	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
33	1306045083	OTHER	IL	INDIVIDUAL NPI
37	1659412682	OTHER	IN	NPI INDIVIDUAL HASSAN A SHAH, MD
38	1881759694	OTHER	IL	NPI INDIVIDUAL KARL TICHO, MD
39	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
41	60180260001	OTHER	IL	DEMERC SUPPLIER PTAN

General Provider Information

NPI Number	:	1083684922
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE EYE SPECIALISTS CENTER LLC

Provider Business Mailing Address
First Line	:	DEPARTMENT 4684
Second Line	:
City	:	CAROL STREAM
State	:	IL
Zip	:	60122-4684
Country	:	US
Telephone Number	:	708-952-0329
Fax Number	:	708-952-0329

Provider Business Practice Location Address
First Line	:	10436 SOUTHWEST HWY
Second Line	:
City	:	CHICAGO RIDGE
State	:	IL
Zip	:	60415-2282
Country	:	US
Telephone Number	:	708-423-4070
Fax Number	:	708-423-4216

Authorized Official
Title or Position	:	OWNER/PARTNER/PHYSICIAN
Name	:	DR. JONATHAN S BUKA
Credential	:	M.D.
Telephone Number	:	708-423-4070

Provider Enumeration Date	:	01/24/2006
Last Update Date	:	01/23/2018

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Directions to “THE EYE SPECIALISTS CENTER LLC ” Practice Location

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