Provider Demographics
NPI:1225224165
Name:DEMPSTER EYE CARE PC
Entity Type:Organization
Organization Name:DEMPSTER EYE CARE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SUN
Authorized Official - Middle Name:AE
Authorized Official - Last Name:MA
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:847-470-1115
Mailing Address - Street 1:5901 DEMPSTER ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:MORTON GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60053-3014
Mailing Address - Country:US
Mailing Address - Phone:847-470-1115
Mailing Address - Fax:847-470-1141
Practice Address - Street 1:5901 DEMPSTER ST
Practice Address - Street 2:SUITE 101
Practice Address - City:MORTON GROVE
Practice Address - State:IL
Practice Address - Zip Code:60053-3014
Practice Address - Country:US
Practice Address - Phone:847-470-1115
Practice Address - Fax:847-470-1141
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-24
Last Update Date:2011-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046-008065152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL994610Medicare PIN