MEDICARE: OLYMPIA FIELDS EYECARE, 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	207W00000X	Ophthalmology Physician	042007134	IL

Other Identifiers

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

General Provider Information

NPI Number	:	1598762007
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OLYMPIA FIELDS EYECARE, LTD.

Provider Business Mailing Address
First Line	:	19740 GOVERNORS HWY STE 124
Second Line	:
City	:	FLOSSMOOR
State	:	IL
Zip	:	60422-2085
Country	:	US
Telephone Number	:	708-957-1618
Fax Number	:	708-748-7305

Provider Business Practice Location Address
First Line	:	19740 GOVERNORS HWY STE 124
Second Line	:
City	:	FLOSSMOOR
State	:	IL
Zip	:	60422-2085
Country	:	US
Telephone Number	:	708-748-5202
Fax Number	:	708-748-7305

Authorized Official
Title or Position	:	OWNER
Name	:	SHARON S. BURKE
Credential	:	M.D.
Telephone Number	:	708-957-1618

Provider Enumeration Date	:	06/30/2005
Last Update Date	:	03/09/2018

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Directions to “OLYMPIA FIELDS EYECARE, LTD. ” Practice Location

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