Provider Demographics
NPI:1467940254
Name:OPHTHALMOLOGY CONSULTANTS OF ILLINOIS, S.C.
Entity Type:Organization
Organization Name:OPHTHALMOLOGY CONSULTANTS OF ILLINOIS, S.C.
Other - Org Name:ARCHER EYE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BABU
Authorized Official - Middle Name:NARAYAN
Authorized Official - Last Name:PONAKALA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:630-964-9800
Mailing Address - Street 1:409 W OGDEN AVE
Mailing Address - Street 2:
Mailing Address - City:WESTMONT
Mailing Address - State:IL
Mailing Address - Zip Code:60559-1421
Mailing Address - Country:US
Mailing Address - Phone:309-649-8006
Mailing Address - Fax:888-598-6004
Practice Address - Street 1:7001 W ARCHER AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60638-2201
Practice Address - Country:US
Practice Address - Phone:773-229-8818
Practice Address - Fax:773-229-8423
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:OPHTHALMOLOGY CONSULTANTS OF IL, SC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-04-26
Last Update Date:2018-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
No152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty