Provider Demographics
NPI:1275739518
Name:RETINA MACULA SPECIALISTS, P.C.
Entity Type:Organization
Organization Name:RETINA MACULA SPECIALISTS, P.C.
Other - Org Name:BOLINGBROOK DIABETIC EYE CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT.
Authorized Official - Prefix:DR
Authorized Official - First Name:IRMA
Authorized Official - Middle Name:
Authorized Official - Last Name:AHMED
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:630-783-9960
Mailing Address - Street 1:550 E. BOUGHTON ROAD SUITE 120
Mailing Address - Street 2:
Mailing Address - City:BILINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440
Mailing Address - Country:US
Mailing Address - Phone:630-783-9960
Mailing Address - Fax:630-783-9962
Practice Address - Street 1:550 E. BOUGHTON ROAD SUITE 120
Practice Address - Street 2:
Practice Address - City:BILINGBROOK
Practice Address - State:IL
Practice Address - Zip Code:60440
Practice Address - Country:US
Practice Address - Phone:630-783-9960
Practice Address - Fax:630-783-9962
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-25
Last Update Date:2018-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036101438207WX0107X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina SpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036101438Medicaid
IL215624Medicare PIN
IL036101438Medicaid
G38002Medicare UPIN