MEDICARE: OPHTHALMIC SUPPORT SYTEMS OF CHICAGO

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	332B00000X	Durable Medical Equipment & Medical Supplies	PENDING	IL

General Provider Information

NPI Number	:	1720167141
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OPHTHALMIC SUPPORT SYTEMS OF CHICAGO

Provider Business Mailing Address
First Line	:	1942 W WOLFRAM ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60657-4032
Country	:	US
Telephone Number	:	773-404-2148
Fax Number	:	773-404-9270

Provider Business Practice Location Address
First Line	:	1942 W WOLFRAM ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60657-4032
Country	:	US
Telephone Number	:	773-404-2148
Fax Number	:	773-404-9270

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MRS. SYBIL ANITA MONTGOMERY
Credential	:
Telephone Number	:	773-404-2148

Provider Enumeration Date	:	11/05/2006
Last Update Date	:	08/22/2020

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