Provider Demographics
NPI:1629463039
Name:SR CORNEA CONSULTANTS SC
Entity Type:Organization
Organization Name:SR CORNEA CONSULTANTS SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SANJAY
Authorized Official - Middle Name:N
Authorized Official - Last Name:RAO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-668-5498
Mailing Address - Street 1:16 KIMBERLEY CIR
Mailing Address - Street 2:
Mailing Address - City:OAK BROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60523-1719
Mailing Address - Country:US
Mailing Address - Phone:847-668-5498
Mailing Address - Fax:312-641-5503
Practice Address - Street 1:180 N MICHIGAN AVE
Practice Address - Street 2:STE 1900
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60601-7401
Practice Address - Country:US
Practice Address - Phone:312-553-1818
Practice Address - Fax:312-641-5503
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-02
Last Update Date:2020-11-18
Deactivation Date:2020-11-12
Deactivation Code:
Reactivation Date:2020-11-18
Provider Licenses
StateLicense IDTaxonomies
IL036102488207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty