Provider Demographics
NPI:1205957149
Name:DOLTON OPTOMETRIC CENTER, P.C.
Entity type:Organization
Organization Name:DOLTON OPTOMETRIC CENTER, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:B
Authorized Official - Last Name:LEVINSON
Authorized Official - Suffix:
Authorized Official - Credentials:OD, FAAO
Authorized Official - Phone:708-849-0690
Mailing Address - Street 1:14223 CHICAGO RD
Mailing Address - Street 2:
Mailing Address - City:DOLTON
Mailing Address - State:IL
Mailing Address - Zip Code:60419-1203
Mailing Address - Country:US
Mailing Address - Phone:708-849-0690
Mailing Address - Fax:708-849-0344
Practice Address - Street 1:14223 CHICAGO RD
Practice Address - Street 2:
Practice Address - City:DOLTON
Practice Address - State:IL
Practice Address - Zip Code:60419-1203
Practice Address - Country:US
Practice Address - Phone:708-849-0690
Practice Address - Fax:708-849-0344
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-02
Last Update Date:2010-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046-0074685261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0143480001Medicare NSC
ILCF2117Medicare PIN