Provider Demographics
NPI:1376656686
Name:RIDGE OPTICAL
Entity Type:Organization
Organization Name:RIDGE OPTICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:H
Authorized Official - Last Name:KAPLAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-823-2140
Mailing Address - Street 1:444 N NORTHWEST HWY
Mailing Address - Street 2:RIDGE OPTICAL
Mailing Address - City:PARK RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60068-3263
Mailing Address - Country:US
Mailing Address - Phone:847-823-2140
Mailing Address - Fax:
Practice Address - Street 1:444 N NORTHWEST HWY
Practice Address - Street 2:RIDGE OPTICAL
Practice Address - City:PARK RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60068-3263
Practice Address - Country:US
Practice Address - Phone:847-823-2140
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-17
Last Update Date:2009-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILG95212Medicare UPIN
ILF45052Medicare UPIN
IL5257990001Medicare NSC
ILG44377Medicare UPIN