Provider Demographics
NPI:1043589963
Name:MIDWEST EYE, P.C.
Entity Type:Organization
Organization Name:MIDWEST EYE, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TODD
Authorized Official - Middle Name:
Authorized Official - Last Name:ROBERT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-345-7005
Mailing Address - Street 1:10215 W ROOSEVELT RD
Mailing Address - Street 2:
Mailing Address - City:WESTCHESTER
Mailing Address - State:IL
Mailing Address - Zip Code:60154-2576
Mailing Address - Country:US
Mailing Address - Phone:708-345-7005
Mailing Address - Fax:708-345-7043
Practice Address - Street 1:10215 W ROOSEVELT RD
Practice Address - Street 2:
Practice Address - City:WESTCHESTER
Practice Address - State:IL
Practice Address - Zip Code:60154-2576
Practice Address - Country:US
Practice Address - Phone:708-345-7005
Practice Address - Fax:708-345-7043
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-21
Last Update Date:2011-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
T35510Medicare UPIN
L72474Medicare PIN