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NPI Code Detail

MEDICARE: ELMHURST EYE SURGERY CENTER

MEDICARE: ELMHURST EYE SURGERY CENTER
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
1261QS0132XOphthalmologic Surgery Clinic/CenterIL

General Provider Information

NPI Number : 1790983914
Entity Type Code : Organization
Provider Name (Legal Business Name) : ELMHURST EYE SURGERY CENTER
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 : 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
Authorized Official
Title or Position : PHYSICIAN
Name : DR. KEVIN J KOVACH
Credential : M.D.
Telephone Number : 630-833-9621
Provider Enumeration Date : 07/10/2007
Last Update Date : 07/10/2007

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Directions to “ELMHURST EYE SURGERY CENTER ” Practice Location

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