Provider Demographics
NPI:1669498267
Name:KOVACH EYE INSTITUTE, LTD
Entity Type:Organization
Organization Name:KOVACH EYE INSTITUTE, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:J
Authorized Official - Last Name:KOVACH
Authorized Official - Suffix:
Authorized Official - Credentials:COE
Authorized Official - Phone:630-833-9621
Mailing Address - Street 1:152 N ADDISON AVE
Mailing Address - Street 2:
Mailing Address - City:ELMHURST
Mailing Address - State:IL
Mailing Address - Zip Code:60126-2821
Mailing Address - Country:US
Mailing Address - Phone:630-833-9621
Mailing Address - Fax:630-833-9465
Practice Address - Street 1:152 N ADDISON AVE
Practice Address - Street 2:
Practice Address - City:ELMHURST
Practice Address - State:IL
Practice Address - Zip Code:60126
Practice Address - Country:US
Practice Address - Phone:630-833-9621
Practice Address - Fax:630-833-9465
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-15
Last Update Date:2018-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL042-616829207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL02222949OtherBLUE SHIELD OF ILLINOIS
ILCG2135OtherPALMETTO GBA
IL02222949OtherBLUE SHIELD OF ILLINOIS
IL542440Medicare PIN