Provider Demographics
NPI:1073614863
Name:EVANSTON OPHTHALMOLOGISTS, S.C.
Entity Type:Organization
Organization Name:EVANSTON OPHTHALMOLOGISTS, S.C.
Other - Org Name:MYERS WYSE CENTER FOR THE EYE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:G
Authorized Official - Last Name:MYERS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-328-2020
Mailing Address - Street 1:4709 GOLF RD
Mailing Address - Street 2:TWELFTH FLOOR
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60076-1231
Mailing Address - Country:US
Mailing Address - Phone:847-328-2020
Mailing Address - Fax:847-328-0523
Practice Address - Street 1:4709 GOLF RD
Practice Address - Street 2:TWELFTH FLOOR
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60076-1231
Practice Address - Country:US
Practice Address - Phone:847-328-2020
Practice Address - Fax:847-328-0523
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-26
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL36059607207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILBC7331438OtherA. COHEN, MD DEA
ILBW4472368OtherT. WYSE, MD DEA
ILAM9014541OtherW. MYERS, MD DEA
ILBB9166768OtherJ. BIRD, MD DEA
ILBB9166768OtherJ. BIRD, MD DEA
ILBC7331438OtherA. COHEN, MD DEA
ILD155092Medicare UPIN
ILH46828Medicare UPIN