Provider Demographics
NPI:1750468518
Name:CHICAGO CORNEA CONSULTANTS LTD
Entity Type:Organization
Organization Name:CHICAGO CORNEA CONSULTANTS LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATIONG OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:STUART
Authorized Official - Middle Name:E
Authorized Official - Last Name:SCHWARTZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-432-6010
Mailing Address - Street 1:806 CENTRAL AVE
Mailing Address - Street 2:STE 300
Mailing Address - City:HIGHLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60035-5613
Mailing Address - Country:US
Mailing Address - Phone:847-432-6010
Mailing Address - Fax:847-432-8241
Practice Address - Street 1:806 CENTRAL AVE
Practice Address - Street 2:STE 300
Practice Address - City:HIGHLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60035-5613
Practice Address - Country:US
Practice Address - Phone:847-432-6010
Practice Address - Fax:847-432-8241
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2012-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL042006466152WC0802X, 207W00000X
IL042116466156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact ManagementGroup - Single Specialty
No156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL793820Medicare PIN
IL793821Medicare PIN
IL594760Medicare PIN
IL594770Medicare PIN
IL793823Medicare PIN