Provider Demographics
NPI:1578738670
Name:METRO EYE CARE
Entity Type:Organization
Organization Name:METRO EYE CARE
Other - Org Name:EVARISTUS UDOISA
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EVARISTUS
Authorized Official - Middle Name:
Authorized Official - Last Name:UDOISA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:630-790-2929
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:630-790-2929
Mailing Address - Fax:630-790-2930
Practice Address - Street 1:326 W 64TH ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60621-3114
Practice Address - Country:US
Practice Address - Phone:630-790-2929
Practice Address - Fax:630-790-2930
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-29
Last Update Date:2008-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0360658588207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0360658588Medicaid
IL726010Medicare PIN
IL0360658588Medicaid