MEDICARE: VILLAGE EYE PHYSICIANS 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	036090975	IL

General Provider Information

NPI Number	:	1689986754
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VILLAGE EYE PHYSICIANS LTD

Provider Business Mailing Address
First Line	:	152 N ADDISON AVE
Second Line	:
City	:	ELMHURST
State	:	IL
Zip	:	60126-2821
Country	:	US
Telephone Number	:	630-833-9621
Fax Number	:	630-833-9465

Provider Business Practice Location Address
First Line	:	1046 CHICAGO AVE
Second Line	:
City	:	OAK PARK
State	:	IL
Zip	:	60302-1842
Country	:	US
Telephone Number	:	630-833-9621
Fax Number	:	630-833-9465

Authorized Official
Title or Position	:	PRESIDENT
Name	:	KEVIN J KOVACH
Credential	:	M.D.
Telephone Number	:	708-848-4353

Provider Enumeration Date	:	07/06/2010
Last Update Date	:	06/20/2018

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