Provider Demographics
NPI:1750507042
Name:CENTER FOR VITREO RETINAL DISEASES
Entity Type:Organization
Organization Name:CENTER FOR VITREO RETINAL DISEASES
Other - Org Name:IRA GAROON, M.D.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:IRA
Authorized Official - Middle Name:
Authorized Official - Last Name:GAROON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-294-0080
Mailing Address - Street 1:9301 GOLF RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:DES PLAINES
Mailing Address - State:IL
Mailing Address - Zip Code:60016-1667
Mailing Address - Country:US
Mailing Address - Phone:847-294-0080
Mailing Address - Fax:847-294-0193
Practice Address - Street 1:9301 GOLF RD
Practice Address - Street 2:SUITE 102
Practice Address - City:DES PLAINES
Practice Address - State:IL
Practice Address - Zip Code:60016-1667
Practice Address - Country:US
Practice Address - Phone:847-294-0080
Practice Address - Fax:847-294-0193
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-17
Last Update Date:2021-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036058218207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========OtherTAX IDENTIFICATION NUMBER