Provider Demographics
NPI:1275653263
Name:CHICAGO OPHTHALMOLOGY, P.C.
Entity Type:Organization
Organization Name:CHICAGO OPHTHALMOLOGY, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:STEVEN
Authorized Official - Last Name:DOREN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:773-935-2800
Mailing Address - Street 1:3000 N HALSTED ST
Mailing Address - Street 2:SUITE 501
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-5188
Mailing Address - Country:US
Mailing Address - Phone:773-935-2800
Mailing Address - Fax:773-935-2861
Practice Address - Street 1:3000 N HALSTED ST
Practice Address - Street 2:SUITE 501
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-5188
Practice Address - Country:US
Practice Address - Phone:773-935-2800
Practice Address - Fax:773-935-2861
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-31
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
IL01620224OtherBCBS ID NUMBER
ILP00266736OtherRAILROAD MEDICARE ID #
IL146050551101OtherHUMANA ID #
IL0000001274OtherFAMILY MEDICAL NETWORK ID
IL5237392OtherAETNA ID #
IL01620224OtherBCBS ID NUMBER
IL5237392OtherAETNA ID #
IL=========OtherUNITED HEALTHCARE ID #
IL=========OtherUNITED HEALTHCARE ID #