Provider Demographics
NPI:1659557858
Name:EYE CARE GROUP LTD
Entity Type:Organization
Organization Name:EYE CARE GROUP LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INDEPENDENT PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:AHUJA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:773-318-8487
Mailing Address - Street 1:PO BOX 10616
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60610-0616
Mailing Address - Country:US
Mailing Address - Phone:773-318-8487
Mailing Address - Fax:
Practice Address - Street 1:840 W IRVING PARK RD
Practice Address - Street 2:SUITE 401
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60613-3011
Practice Address - Country:US
Practice Address - Phone:773-975-6868
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-17
Last Update Date:2014-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036102643207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL705680Medicare PIN