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NPI Code Detail

MEDICARE: OPHTHALMOLOGY SURGERY CENTER OF ILLINOIS, LLC

MEDICARE: OPHTHALMOLOGY SURGERY CENTER OF ILLINOIS, 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
1261QA1903XAmbulatory Surgical Clinic/Center

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1248002884OTHERILAMBULATORY SURGICAL CENTER LICENSE

General Provider Information

NPI Number : 1497314181
Entity Type Code : Organization
Provider Name (Legal Business Name) : OPHTHALMOLOGY SURGERY CENTER OF ILLINOIS, LLC
Provider Business Mailing Address
First Line : 1300 N ARLINGTON HEIGHTS RD STE 150
Second Line :
City : ITASCA
State : IL
Zip : 60143-3128
Country : US
Telephone Number : 630-634-2980
Fax Number : 630-625-8116
Provider Business Practice Location Address
First Line : 1300 N ARLINGTON HEIGHTS RD STE 150
Second Line :
City : ITASCA
State : IL
Zip : 60143-3128
Country : US
Telephone Number : 630-634-2980
Fax Number : 630-625-8116
Authorized Official
Title or Position : PRESIDENT
Name : KEVIN J KOVACH
Credential : MD
Telephone Number : 630-634-2980
Provider Enumeration Date : 06/06/2019
Last Update Date : 08/03/2021

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