Provider Demographics
NPI:1144208596
Name:JAMES C LIANG MD SC
Entity Type:Organization
Organization Name:JAMES C LIANG MD SC
Other - Org Name:RETINA MACULA CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:C
Authorized Official - Last Name:LIANG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:708-422-2665
Mailing Address - Street 1:4429 W 95TH ST
Mailing Address - Street 2:
Mailing Address - City:OAK LAWN
Mailing Address - State:IL
Mailing Address - Zip Code:60453-2625
Mailing Address - Country:US
Mailing Address - Phone:708-422-2665
Mailing Address - Fax:708-422-2997
Practice Address - Street 1:4429 W 95TH ST
Practice Address - Street 2:
Practice Address - City:OAK LAWN
Practice Address - State:IL
Practice Address - Zip Code:60453-2625
Practice Address - Country:US
Practice Address - Phone:708-422-2665
Practice Address - Fax:708-422-2997
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-05
Last Update Date:2009-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036051267207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036051267Medicaid
IL209505Medicare ID - Type Unspecified
IL036051267Medicaid