Provider Demographics
NPI:1538477021
Name:METRO CONSULTANTS & PHYSICIANS EYE CARE
Entity Type:Organization
Organization Name:METRO CONSULTANTS & PHYSICIANS EYE CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:EVARISTUS
Authorized Official - Middle Name:FERGUSON
Authorized Official - Last Name:UDOISA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:773-651-6977
Mailing Address - Street 1:2155 HIGH ST
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:IL
Mailing Address - Zip Code:60163-1534
Mailing Address - Country:US
Mailing Address - Phone:773-651-6977
Mailing Address - Fax:773-651-3978
Practice Address - Street 1:326 WEST 64TH STREET
Practice Address - Street 2:SUITE 214 ST. BERNARD HOSP. PROF. PAVILION
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60621
Practice Address - Country:US
Practice Address - Phone:773-651-6977
Practice Address - Fax:773-651-3978
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-17
Last Update Date:2010-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center