Provider Demographics
NPI:1124040001
Name:PLAINFIELD OPHTHALMOLOGY, M.D., S.C.
Entity Type:Organization
Organization Name:PLAINFIELD OPHTHALMOLOGY, M.D., S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:OPPENHEIM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:815-609-6989
Mailing Address - Street 1:13300 S ROUTE 59
Mailing Address - Street 2:BUILDING A, SUITE A1
Mailing Address - City:PLAINFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60585-9847
Mailing Address - Country:US
Mailing Address - Phone:815-609-6989
Mailing Address - Fax:
Practice Address - Street 1:13300 S ROUTE 59
Practice Address - Street 2:BUILDING A, SUITE A1
Practice Address - City:PLAINFIELD
Practice Address - State:IL
Practice Address - Zip Code:60585-9847
Practice Address - Country:US
Practice Address - Phone:815-609-6989
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty