MEDICARE: DR. ERIC TSENG 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
1	152W00000X	Optometrist	046010071	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
2	IL2815001	OTHER	IL	PTAN
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1629233580
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ERIC TSENG O.D,

Provider Business Mailing Address
First Line	:	9928 S WESTERN AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60643-1831
Country	:	US
Telephone Number	:	773-303-8279
Fax Number	:	773-681-7119

Provider Business Practice Location Address
First Line	:	9928 S WESTERN AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60643-1831
Country	:	US
Telephone Number	:	773-303-8279
Fax Number	:	773-681-7119

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/21/2008
Last Update Date	:	08/17/2015

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