Provider Demographics
NPI:1851616171
Name:LINAS A SIDRYS
Entity Type:Organization
Organization Name:LINAS A SIDRYS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LINAS
Authorized Official - Middle Name:A
Authorized Official - Last Name:SIDRYS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:708-636-6622
Mailing Address - Street 1:5850 W 111TH ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60415-2220
Mailing Address - Country:US
Mailing Address - Phone:708-626-6622
Mailing Address - Fax:
Practice Address - Street 1:5850 W 111TH ST
Practice Address - Street 2:
Practice Address - City:CHICAGO RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60415-2220
Practice Address - Country:US
Practice Address - Phone:708-626-6622
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-30
Last Update Date:2010-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0981200001Medicare NSC