MEDICARE: JOHN C ENGSTROM, OD, LTD

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	152W00000X	Optometrist

General Provider Information

NPI Number	:	1427063874
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JOHN C ENGSTROM, OD, LTD

Provider Business Mailing Address
First Line	:	3487 KIRCHOFF RD
Second Line	:
City	:	ROLLING MEADOWS
State	:	IL
Zip	:	60008-1842
Country	:	US
Telephone Number	:	847-255-6075
Fax Number	:	847-255-0880

Provider Business Practice Location Address
First Line	:	3487 KIRCHOFF RD
Second Line	:
City	:	ROLLING MEADOWS
State	:	IL
Zip	:	60008-1842
Country	:	US
Telephone Number	:	847-255-6075
Fax Number	:	847-255-0880

Authorized Official
Title or Position	:	PRESIDENT/SECRETARY
Name	:	DR. JOHN C ENGSTROM
Credential	:	O.D.
Telephone Number	:	847-255-6075

Provider Enumeration Date	:	07/31/2006
Last Update Date	:	06/03/2008

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