Provider Demographics
NPI:1972794451
Name:GOREN EYE ASSOCIATES, SC
Entity Type:Organization
Organization Name:GOREN EYE ASSOCIATES, SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:BRENT
Authorized Official - Last Name:GOREN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:312-332-2262
Mailing Address - Street 1:180 N STETSON AVE
Mailing Address - Street 2:SUITE 3175
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60601-6710
Mailing Address - Country:US
Mailing Address - Phone:312-332-2262
Mailing Address - Fax:
Practice Address - Street 1:180 N STETSON AVE
Practice Address - Street 2:SUITE 3175
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60601-6710
Practice Address - Country:US
Practice Address - Phone:312-332-2262
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-08
Last Update Date:2007-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL345370Medicare UPIN