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NPI Code Detail

MEDICARE: ERWIN WILLIAM OVITSKY O.D.

MEDICARE: ERWIN WILLIAM OVITSKY O.D.
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
1152W00000XOptometrist046.010928IL

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
3P01538936OTHERILRAILROAD MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1558746297
Entity Type Code : Individual
Provider Name (Legal Business Name) : ERWIN WILLIAM OVITSKY O.D.
Provider Business Mailing Address
First Line : 3500 W PETERSON AVE STE 401
Second Line :
City : CHICAGO
State : IL
Zip : 60659-3307
Country : US
Telephone Number : 773-588-3090
Fax Number :
Provider Business Practice Location Address
First Line : 3500 W PETERSON AVE STE 401
Second Line :
City : CHICAGO
State : IL
Zip : 60659-3307
Country : US
Telephone Number : 773-588-3090
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/23/2015
Last Update Date : 09/04/2018

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Directions to “ ERWIN WILLIAM OVITSKY O.D.” Practice Location

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