Provider Demographics
NPI:1043225535
Name:EYES OF GRACE SC
Entity Type:Organization
Organization Name:EYES OF GRACE SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:GRACE
Authorized Official - Middle Name:
Authorized Official - Last Name:BAI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-933-0800
Mailing Address - Street 1:PO BOX 5178
Mailing Address - Street 2:
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60076-5178
Mailing Address - Country:US
Mailing Address - Phone:847-933-3555
Mailing Address - Fax:847-933-3559
Practice Address - Street 1:9669 KENTON AVE STE 409
Practice Address - Street 2:
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60076-1267
Practice Address - Country:US
Practice Address - Phone:847-933-0800
Practice Address - Fax:855-329-4224
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-31
Last Update Date:2019-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036103366Medicaid
IL01633731OtherBS OF IL
G91309Medicare UPIN
207385Medicare ID - Type Unspecified