Provider Demographics
NPI:1619026184
Name:SMITH PERRY EYE CENTER S.C.
Entity Type:Organization
Organization Name:SMITH PERRY EYE CENTER S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:D
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:630-789-6700
Mailing Address - Street 1:950 N YORK RD
Mailing Address - Street 2:SUITE 203
Mailing Address - City:HINSDALE
Mailing Address - State:IL
Mailing Address - Zip Code:60521-2950
Mailing Address - Country:US
Mailing Address - Phone:630-789-6700
Mailing Address - Fax:630-789-3909
Practice Address - Street 1:950 N YORK RD
Practice Address - Street 2:SUITE 203
Practice Address - City:HINSDALE
Practice Address - State:IL
Practice Address - Zip Code:60521-2950
Practice Address - Country:US
Practice Address - Phone:630-789-6700
Practice Address - Fax:630-789-3909
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-10
Last Update Date:2008-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036079800207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL5414400001Medicare NSC