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NPI Code Detail

MEDICARE: LAKESHORE EYE PHYSICIANS AND SURGEONS SC

MEDICARE: LAKESHORE EYE PHYSICIANS AND SURGEONS SC
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
1207W00000XOphthalmology PhysicianIL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11618098OTHERILBCBS

General Provider Information

NPI Number : 1548275985
Entity Type Code : Organization
Provider Name (Legal Business Name) : LAKESHORE EYE PHYSICIANS AND SURGEONS SC
Provider Business Mailing Address
First Line : 7080 NORTH WESTERN AVENUE
Second Line :
City : CHICAGO
State : IL
Zip : 60645
Country : US
Telephone Number : 773-465-7777
Fax Number : 773-761-9226
Provider Business Practice Location Address
First Line : 7200 NORTH WESTERN AVENUE
Second Line :
City : CHICAGO
State : IL
Zip : 60645-1812
Country : US
Telephone Number : 773-743-6700
Fax Number : 773-761-9226
Authorized Official
Title or Position : PRESIDENT
Name : HOWARD JOEL REINGLASS
Credential : MD
Telephone Number : 773-743-6700
Provider Enumeration Date : 07/31/2006
Last Update Date : 08/22/2020

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Directions to “LAKESHORE EYE PHYSICIANS AND SURGEONS SC ” Practice Location

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