Provider Demographics
NPI:1720365661
Name:OPHTHALMIC CONSULTANTS OF CHICAGO, LLC
Entity Type:Organization
Organization Name:OPHTHALMIC CONSULTANTS OF CHICAGO, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:MACK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-755-9393
Mailing Address - Street 1:1220 W HIGGINS RD
Mailing Address - Street 2:STE 102
Mailing Address - City:HOFFMAN ESTATES
Mailing Address - State:IL
Mailing Address - Zip Code:60169-4033
Mailing Address - Country:US
Mailing Address - Phone:847-755-9393
Mailing Address - Fax:847-755-1560
Practice Address - Street 1:1220 W HIGGINS RD
Practice Address - Street 2:STE 102
Practice Address - City:HOFFMAN ESTATES
Practice Address - State:IL
Practice Address - Zip Code:60169
Practice Address - Country:US
Practice Address - Phone:847-755-9393
Practice Address - Fax:847-755-1560
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-07
Last Update Date:2012-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036090403207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty