Provider Demographics
NPI:1083684922
Name:THE EYE SPECIALISTS CENTER LLC
Entity type:Organization
Organization Name:THE EYE SPECIALISTS CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PARTNER/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:S
Authorized Official - Last Name:BUKA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:708-423-4070
Mailing Address - Street 1:DEPARTMENT 4684
Mailing Address - Street 2:
Mailing Address - City:CAROL STREAM
Mailing Address - State:IL
Mailing Address - Zip Code:60122-4684
Mailing Address - Country:US
Mailing Address - Phone:708-952-0329
Mailing Address - Fax:708-952-0329
Practice Address - Street 1:10436 SOUTHWEST HWY
Practice Address - Street 2:
Practice Address - City:CHICAGO RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60415-2282
Practice Address - Country:US
Practice Address - Phone:708-423-4070
Practice Address - Fax:708-423-4216
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-24
Last Update Date:2018-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1659412682OtherNPI IDIVIDUAL HASSAN SHAH, MD
IL1679551014OtherNPI INDIVIDUAL
IL1770544462OtherNPI INDIVIDUAL EMMET M. CASSIDY, MD
IL180046208OtherMEDICARE RAILROAD
IL205786OtherPTAN IL MEDICARE DUPAGE COUNTY
ILCK7818OtherMEDICARE RAILROAD GRP PTAN
IL036126041Medicaid
IL1649256512OtherNPI INDIVIDUAL ALEXANDER J KHAMMAR, MD
IL1689988446OtherNPI INDIVIDUAL CHRISTINA M TWARDOWSKI, OD
ILPTAN P00638025OtherRAILROAD MEDICARE
IL036128553OtherPHYSICIANS LICENSE
IL047935428Medicaid
IN200871680DOtherMEDICAID LOCATION HINSDALE
ILP00638025OtherMEDICARE RAILROAD
IL036128553Medicaid
IL1386637791OtherINDIVIDUAL NPI
IL1992782494OtherNPI INDIVIDUAL BENJAMIN H TICHO
IN200871680BOtherMEDICAID LOCATION CHICAGO RIDGE
IL205785OtherPTAN IL MEDICARE COOK COUNTY
IL01620861OtherBLUE CROSS AND BLUE SHEILD OF ILLINOIS
IL036123095Medicaid
IL046009799OtherLICENSE NO
IL1477522050OtherNPI INDIVIDUAL JONATHAN S BUKA, MD
IL1699802421OtherOPTICAL NPI THE EYE SPECIALISTS CENTER
IL1700047222OtherNPI DR SHIFRIN
IN1700047222OtherNPI INDIVIDUAL KABITA S SHIFRIN, DO
IL180046211OtherMEDICARE RAILROAD
IL12324832OtherCAQH R. VASAIWALA, MD
IN1477522050OtherNPI INDIVIDUAL JONATHAN S BUKA, MD
IN1649256512OtherNPI INDIVIDUAL ALEXANDER J KHAMMAR, MD
IN200871680COtherMEDICAID LOCATION ORLAND PARK
IL047935429Medicaid
IL1306045083OtherINDIVIDUAL NPI
IL180046209OtherMEDICARE RAILROAD
IL180046210OtherMEDICARE RAILROAD
IL180046212OtherMEDICARE RAILROAD
IN1659412682OtherNPI INDIVIDUAL HASSAN A SHAH, MD
IL1881759694OtherNPI INDIVIDUAL KARL TICHO, MD
IN200871680AOtherMEDICAID LOCATION MUNSTER
IN253350OtherPTAN INDIANA MEDICARE GROUP
IL60180260001OtherDEMERC SUPPLIER PTAN
IL047935428Medicaid
IL180046209OtherMEDICARE RAILROAD
IL1881759694OtherNPI INDIVIDUAL KARL TICHO, MD
IL036123095Medicaid
IN1477522050OtherNPI INDIVIDUAL JONATHAN S BUKA, MD