MEDICARE: DOLTON OPTOMETRIC CENTER, P.C.

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	046-0074685	IL

General Provider Information

NPI Number	:	1205957149
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DOLTON OPTOMETRIC CENTER, P.C.

Provider Business Mailing Address
First Line	:	14223 CHICAGO RD
Second Line	:
City	:	DOLTON
State	:	IL
Zip	:	60419-1203
Country	:	US
Telephone Number	:	708-849-0690
Fax Number	:	708-849-0344

Provider Business Practice Location Address
First Line	:	14223 CHICAGO RD
Second Line	:
City	:	DOLTON
State	:	IL
Zip	:	60419-1203
Country	:	US
Telephone Number	:	708-849-0690
Fax Number	:	708-849-0344

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JAMES B LEVINSON
Credential	:	O.D., F.A.A.O.
Telephone Number	:	708-849-0690

Provider Enumeration Date	:	04/02/2007
Last Update Date	:	02/11/2010

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