Provider Demographics
NPI:1598809659
Name:SULLIVAN OSTOICH EYE CARE LTD
Entity Type:Organization
Organization Name:SULLIVAN OSTOICH EYE CARE LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:L
Authorized Official - Last Name:SULLIVAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-776-8900
Mailing Address - Street 1:1415 PALATINE RD
Mailing Address - Street 2:
Mailing Address - City:HOFFMAN ESTATES
Mailing Address - State:IL
Mailing Address - Zip Code:60192-1196
Mailing Address - Country:US
Mailing Address - Phone:847-776-8900
Mailing Address - Fax:847-776-8922
Practice Address - Street 1:1415 PALATINE RD
Practice Address - Street 2:
Practice Address - City:HOFFMAN ESTATES
Practice Address - State:IL
Practice Address - Zip Code:60192-1196
Practice Address - Country:US
Practice Address - Phone:847-776-8900
Practice Address - Fax:847-776-8922
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-20
Last Update Date:2022-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL060007756152W00000X, 207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
No152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILCH9269OtherMEDICARE RAILROAD
IL1598809659Medicaid
IL1633189OtherBCBS PROVIDER NUMBER
IL1598809659Medicare PIN
IL209184Medicare PIN