Provider Demographics
NPI:1114008455
Name:THE OPTOMETRISTS, P.C.
Entity Type:Organization
Organization Name:THE OPTOMETRISTS, P.C.
Other - Org Name:THE OPTOMETRISTS OF THE NORTH SHORE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:J
Authorized Official - Last Name:HENDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:847-498-4770
Mailing Address - Street 1:1544 SHERMER RD
Mailing Address - Street 2:
Mailing Address - City:NORTHBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60062-5347
Mailing Address - Country:US
Mailing Address - Phone:847-498-4770
Mailing Address - Fax:847-498-6909
Practice Address - Street 1:1544 SHERMER RD
Practice Address - Street 2:
Practice Address - City:NORTHBROOK
Practice Address - State:IL
Practice Address - Zip Code:60062-5347
Practice Address - Country:US
Practice Address - Phone:847-498-4770
Practice Address - Fax:847-498-6909
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-17
Last Update Date:2022-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL060-008788152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01636744OtherBCBS
IL5799900001Medicare NSC
IL214363Medicare PIN
IL214351Medicare PIN
IL01636744OtherBCBS