Provider Demographics
NPI:1659497071
Name:DENNIS DELEE, O.D., P.C.
Entity Type:Organization
Organization Name:DENNIS DELEE, O.D., P.C.
Other - Org Name:DEAN OPTICAL, LTD.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRES
Authorized Official - Prefix:DR
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:
Authorized Official - Last Name:DELEE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:312-332-4461
Mailing Address - Street 1:209 S LA SALLE ST
Mailing Address - Street 2:STE 120
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60604-1219
Mailing Address - Country:US
Mailing Address - Phone:312-332-4461
Mailing Address - Fax:312-332-5970
Practice Address - Street 1:209 S LA SALLE ST
Practice Address - Street 2:STE 120
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60604-1219
Practice Address - Country:US
Practice Address - Phone:312-332-4461
Practice Address - Fax:312-332-5970
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-21
Last Update Date:2008-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL46-006526152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact ManagementGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILU20826Medicare UPIN
IL598180Medicare PIN