Provider Demographics
NPI:1598121113
Name:GRASSI RETINA MD SC
Entity Type:Organization
Organization Name:GRASSI RETINA MD SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:GRASSI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:630-995-3465
Mailing Address - Street 1:1012 95TH ST
Mailing Address - Street 2:SUITE 9
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60564-5041
Mailing Address - Country:US
Mailing Address - Phone:630-995-3465
Mailing Address - Fax:
Practice Address - Street 1:1012 95TH ST
Practice Address - Street 2:SUITE 9
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60564-5041
Practice Address - Country:US
Practice Address - Phone:630-995-3465
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-12
Last Update Date:2017-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036115845207WX0107X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina SpecialistGroup - Single Specialty