Provider Demographics
NPI:1790746428
Name:MIDWEST EYE CENTER
Entity Type:Organization
Organization Name:MIDWEST EYE CENTER
Other - Org Name:MIDWEST EYE CENTER, S.C.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:L
Authorized Official - Last Name:NEAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:469-214-0144
Mailing Address - Street 1:1700 E WEST RD
Mailing Address - Street 2:
Mailing Address - City:CALUMET CITY
Mailing Address - State:IL
Mailing Address - Zip Code:60409-5415
Mailing Address - Country:US
Mailing Address - Phone:708-891-3330
Mailing Address - Fax:708-891-0904
Practice Address - Street 1:1700 E WEST RD
Practice Address - Street 2:
Practice Address - City:CALUMET CITY
Practice Address - State:IL
Practice Address - Zip Code:60409-5415
Practice Address - Country:US
Practice Address - Phone:708-891-3330
Practice Address - Fax:708-891-0904
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-31
Last Update Date:2020-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
No152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
No261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory SurgicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL141037OtherMEDICARE FACILITY
ILCN5008OtherRAILROAD MEDICARE
IL7001399Medicaid
ILCN5008OtherRAILROAD MEDICARE
IL436360Medicare UPIN
IL7001399Medicaid
IL141037OtherMEDICARE FACILITY