Provider Demographics
NPI:1942242730
Name:WOHL EYE CENTER SC
Entity Type:Organization
Organization Name:WOHL EYE CENTER SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LISA
Authorized Official - Middle Name:G
Authorized Official - Last Name:WOHL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:630-351-2030
Mailing Address - Street 1:303 E ARMY TRAIL RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:BLOOMINGDALE
Mailing Address - State:IL
Mailing Address - Zip Code:60108-2169
Mailing Address - Country:US
Mailing Address - Phone:630-351-2030
Mailing Address - Fax:630-351-3983
Practice Address - Street 1:303 E ARMY TRAIL RD
Practice Address - Street 2:SUITE 200
Practice Address - City:BLOOMINGDALE
Practice Address - State:IL
Practice Address - Zip Code:60108-2169
Practice Address - Country:US
Practice Address - Phone:630-351-2030
Practice Address - Fax:630-351-3983
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-13
Last Update Date:2008-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL180012516OtherRAILROAD MEDICARE
IL02215680OtherBCBS
IL036060734Medicaid
IL741982Medicare ID - Type UnspecifiedGROUP MEDICARE ID
IL0496030001Medicare NSC
ILC47334Medicare UPIN
ILL54108Medicare PIN