Provider Demographics
NPI:1245382126
Name:UNIVERSITY OPHTHALMOLOGY ASSOCIATES, LTD
Entity Type:Organization
Organization Name:UNIVERSITY OPHTHALMOLOGY ASSOCIATES, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:M
Authorized Official - Last Name:STEIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-677-8989
Mailing Address - Street 1:9700 KENTON AVE
Mailing Address - Street 2:SUITE K204
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60076-1259
Mailing Address - Country:US
Mailing Address - Phone:947-677-8989
Mailing Address - Fax:847-677-9008
Practice Address - Street 1:9700 KENTON AVE
Practice Address - Street 2:SUITE K204
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60076-1259
Practice Address - Country:US
Practice Address - Phone:947-677-8989
Practice Address - Fax:847-677-9008
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-18
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
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1608654OtherBLUE CROSS BLUE SHIELD
IL1608654OtherBLUE CROSS BLUE SHIELD