Provider Demographics
NPI:1821265158
Name:OCULAR DIAGNOSTICS SC
Entity Type:Organization
Organization Name:OCULAR DIAGNOSTICS SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:HARRY
Authorized Official - Last Name:FOURNIER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:773-774-2102
Mailing Address - Street 1:5201 N HARLEM AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60656-1803
Mailing Address - Country:US
Mailing Address - Phone:773-774-2102
Mailing Address - Fax:773-774-3581
Practice Address - Street 1:5201 N HARLEM AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60656-1803
Practice Address - Country:US
Practice Address - Phone:773-774-2102
Practice Address - Fax:773-774-3581
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-15
Last Update Date:2008-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL21604189OtherBCBS PROVIDER NO
IL21604189OtherBCBS PROVIDER NO