Provider Demographics
NPI:1225266182
Name:DREY, ERIC M (OD)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:M
Last Name:DREY
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 NORTH LA SALLE STE 155
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60602-4548
Mailing Address - Country:US
Mailing Address - Phone:312-236-7538
Mailing Address - Fax:312-236-1205
Practice Address - Street 1:2 N LA SALLE ST STE 155
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60602-3971
Practice Address - Country:US
Practice Address - Phone:312-236-7538
Practice Address - Fax:312-236-1205
Is Sole Proprietor?:No
Enumeration Date:2009-06-30
Last Update Date:2016-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046010232152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL046010232Medicaid
IL046010232Medicaid