Provider Demographics
NPI:1760592398
Name:UNIVERSITY EYE SPECIALISTS LTD
Entity Type:Organization
Organization Name:UNIVERSITY EYE SPECIALISTS LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPHTHALMOGIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSENBERG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:312-475-1000
Mailing Address - Street 1:676 N ST CLAIR
Mailing Address - Street 2:#1500
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611
Mailing Address - Country:US
Mailing Address - Phone:312-475-1000
Mailing Address - Fax:312-475-1006
Practice Address - Street 1:676 N ST CLAIR
Practice Address - Street 2:#320
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611
Practice Address - Country:US
Practice Address - Phone:312-475-1000
Practice Address - Fax:312-475-1006
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2017-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207WX0009XAllopathic & Osteopathic PhysiciansOphthalmologyGlaucoma SpecialistGroup - Multi-Specialty
No152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
479560Medicare ID - Type Unspecified