Provider Demographics
NPI:1265534523
Name:ROBERT B SCOTT OCULARISTS LTD
Entity type:Organization
Organization Name:ROBERT B SCOTT OCULARISTS LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER/TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:HENRY
Authorized Official - Middle Name:L
Authorized Official - Last Name:BLUM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:312-782-3558
Mailing Address - Street 1:111 N WABASH AVE
Mailing Address - Street 2:SUITE 1620
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60602-3453
Mailing Address - Country:US
Mailing Address - Phone:312-782-3558
Mailing Address - Fax:312-372-4449
Practice Address - Street 1:111 N WABASH AVE
Practice Address - Street 2:SUITE 1620
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60602-3453
Practice Address - Country:US
Practice Address - Phone:312-782-3558
Practice Address - Fax:312-372-4449
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-05
Last Update Date:2024-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
130937200OtherDOL/OWCP
0008730224OtherAETNA
IL0001670147OtherBC/BS OF ILLINOIS
IL=========001Medicaid
IL=========02OtherDSCC
IL0001670147OtherBC/BS OF ILLINOIS
=========0001OtherCIGNA
=========OtherUNITED HEALTHCARE
0008730224OtherAETNA
130937200OtherDOL/OWCP
IL=========OtherVA-CHICAGO HEALTH CARE SY
IL=========OtherDREYER CLINIC, INC
=========OtherUNICARE
0247160001Medicare ID - Type Unspecified