Provider Demographics
NPI:1164455879
Name:REIFF EYE CENTER LTD
Entity Type:Organization
Organization Name:REIFF EYE CENTER LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE COORDINATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:GRAC
Authorized Official - Middle Name:
Authorized Official - Last Name:PENN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-841-8866
Mailing Address - Street 1:1435 N RANDALL RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:ELGIN
Mailing Address - State:IL
Mailing Address - Zip Code:60123-2306
Mailing Address - Country:US
Mailing Address - Phone:847-841-8866
Mailing Address - Fax:847-841-8986
Practice Address - Street 1:1435 N RANDALL RD
Practice Address - Street 2:SUITE 102
Practice Address - City:ELGIN
Practice Address - State:IL
Practice Address - Zip Code:60123-2306
Practice Address - Country:US
Practice Address - Phone:847-841-8866
Practice Address - Fax:847-841-8986
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-08
Last Update Date:2011-05-18
Deactivation Date:2007-10-09
Deactivation Code:
Reactivation Date:2009-02-03
Provider Licenses
StateLicense IDTaxonomies
IL207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036052088Medicaid
IL0635900001Medicare NSC
IL247620Medicare PIN
C39023Medicare UPIN