Provider Demographics
NPI:1649215823
Name:EYE SPECIALISTS OF CHICAGO AND HIGHLAND PARK
Entity Type:Organization
Organization Name:EYE SPECIALISTS OF CHICAGO AND HIGHLAND PARK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INSURANCE COORDINATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:VAL
Authorized Official - Middle Name:
Authorized Official - Last Name:RUEHL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-736-1717
Mailing Address - Street 1:5600 W ADDISON ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60634-4401
Mailing Address - Country:US
Mailing Address - Phone:773-736-1717
Mailing Address - Fax:773-736-7538
Practice Address - Street 1:5600 W ADDISON ST
Practice Address - Street 2:SUITE 102
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60634-4401
Practice Address - Country:US
Practice Address - Phone:773-736-1717
Practice Address - Fax:773-736-7538
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-19
Last Update Date:2012-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL924520Medicare ID - Type UnspecifiedPROVIDER NUMBER
IL206722Medicare ID - Type UnspecifiedPROVIDER NUMBER