Provider Demographics
NPI:1821164039
Name:RETINA SERVICES OF ILLINOIS, LLC
Entity Type:Organization
Organization Name:RETINA SERVICES OF ILLINOIS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:P
Authorized Official - Last Name:SCHROEDER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-972-2700
Mailing Address - Street 1:7447 W TALCOTT AVE STE 345
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60631-3714
Mailing Address - Country:US
Mailing Address - Phone:847-972-2700
Mailing Address - Fax:847-972-2712
Practice Address - Street 1:7447 W TALCOTT AVE STE 345
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60631
Practice Address - Country:US
Practice Address - Phone:847-972-2700
Practice Address - Fax:847-972-2712
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-28
Last Update Date:2018-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-068461207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036095676Medicaid
ILDF4390OtherMEDICARE RETIRED RAILROAD
IL036045862Medicaid
IL1637185OtherBCBS
IL214702OtherMEDICARE
IL036068461Medicaid
IL214701OtherMEDICARE
ILC42299Medicare UPIN
ILK34988Medicare PIN
ILK34990Medicare PIN
ILD16719Medicare UPIN
IL036095676Medicaid
ILK34986Medicare PIN
ILDF4390OtherMEDICARE RETIRED RAILROAD
IL036068461Medicaid
ILK34991Medicare PIN