MEDICARE: COMMUNITY EYE SPECIALISTS

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	046009906	IL

General Provider Information

NPI Number	:	1679716161
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMMUNITY EYE SPECIALISTS

Provider Business Mailing Address
First Line	:	1219 LAURA LN
Second Line	:
City	:	WOODRIDGE
State	:	IL
Zip	:	60517-5063
Country	:	US
Telephone Number	:	312-622-0709
Fax Number	:

Provider Business Practice Location Address
First Line	:	2880 N MILWAUKEE AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60618-7413
Country	:	US
Telephone Number	:	773-486-7661
Fax Number	:	773-486-2821

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. LUIZA MARIA GHEORGHE -YOUSSEFI
Credential	:	O.D.
Telephone Number	:	312-622-0709

Provider Enumeration Date	:	04/13/2009
Last Update Date	:	08/04/2009

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