Provider Demographics
NPI:1891348355
Name:CHICAGOLAND CATARACT AND LASIK SC
Entity Type:Organization
Organization Name:CHICAGOLAND CATARACT AND LASIK SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HERCULES
Authorized Official - Middle Name:D
Authorized Official - Last Name:LOGOTHETIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-362-3811
Mailing Address - Street 1:1880 W WINCHESTER RD STE 105
Mailing Address - Street 2:
Mailing Address - City:LIBERTYVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60048-5321
Mailing Address - Country:US
Mailing Address - Phone:847-362-3811
Mailing Address - Fax:847-362-0428
Practice Address - Street 1:1880 W WINCHESTER RD STE 105
Practice Address - Street 2:
Practice Address - City:LIBERTYVILLE
Practice Address - State:IL
Practice Address - Zip Code:60048-5321
Practice Address - Country:US
Practice Address - Phone:847-362-3811
Practice Address - Fax:847-362-0428
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-23
Last Update Date:2020-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty