Provider Demographics
NPI:1134170541
Name:DUPAGE OPHTHALMOLOGY
Entity type:Organization
Organization Name:DUPAGE OPHTHALMOLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SHERIDAN
Authorized Official - Middle Name:
Authorized Official - Last Name:LAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:630-495-2220
Mailing Address - Street 1:2500 S HIGHLAND AVE
Mailing Address - Street 2:SUITE 110
Mailing Address - City:LOMBARD
Mailing Address - State:IL
Mailing Address - Zip Code:60148-5363
Mailing Address - Country:US
Mailing Address - Phone:630-495-2220
Mailing Address - Fax:630-495-2279
Practice Address - Street 1:2500 S HIGHLAND AVENUE
Practice Address - Street 2:SUITE 110
Practice Address - City:LOMBARD
Practice Address - State:IL
Practice Address - Zip Code:60148-5381
Practice Address - Country:US
Practice Address - Phone:630-495-2220
Practice Address - Fax:630-495-2279
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-12
Last Update Date:2008-07-14
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
ILK27890Medicare UPIN
ILK27889Medicare UPIN
ILK27891Medicare UPIN
IL213619Medicare ID - Type Unspecified