Provider Demographics
NPI:1013085992
Name:RETINA CONSULTANTS, LTD
Entity Type:Organization
Organization Name:RETINA CONSULTANTS, LTD
Other - Org Name:CHARLES M. VYGANTAS MD
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:GINGER
Authorized Official - Middle Name:
Authorized Official - Last Name:ESCHEVERRIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-299-0700
Mailing Address - Street 1:2454 E DEMPSTER ST
Mailing Address - Street 2:400
Mailing Address - City:DES PLAINES
Mailing Address - State:IL
Mailing Address - Zip Code:60016-5315
Mailing Address - Country:US
Mailing Address - Phone:847-299-0700
Mailing Address - Fax:
Practice Address - Street 1:2454 E DEMPSTER ST
Practice Address - Street 2:400
Practice Address - City:DES PLAINES
Practice Address - State:IL
Practice Address - Zip Code:60016-5315
Practice Address - Country:US
Practice Address - Phone:847-299-0700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-01
Last Update Date:2008-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID4030243OtherAETNA
IL180005501OtherRAILROAD MEDICARE
IL21600807OtherBCBS GROUP ID NUMBER
IL21600807OtherBCBS GROUP ID NUMBER
IL454732Medicare ID - Type Unspecified