Provider Demographics
NPI:1376726745
Name:SUSAN JANE TAUB MD SC
Entity Type:Organization
Organization Name:SUSAN JANE TAUB MD SC
Other - Org Name:ALL EYECARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRINCIPAL
Authorized Official - Prefix:DR
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:JANE
Authorized Official - Last Name:TAUB
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:312-735-8208
Mailing Address - Street 1:2650 N LAKEVIEW AVE
Mailing Address - Street 2:1506
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60614-1840
Mailing Address - Country:US
Mailing Address - Phone:312-735-8208
Mailing Address - Fax:312-268-5297
Practice Address - Street 1:1444 S MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60605-4827
Practice Address - Country:US
Practice Address - Phone:312-810-2020
Practice Address - Fax:312-268-5297
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-09
Last Update Date:2007-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILC25156Medicare UPIN