Provider Demographics
NPI:1356497721
Name:CHICAGO EYES LTD
Entity type:Organization
Organization Name:CHICAGO EYES LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:RAFAEL
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:773-743-1221
Mailing Address - Street 1:6200 N CLARK ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60660-1208
Mailing Address - Country:US
Mailing Address - Phone:773-743-1221
Mailing Address - Fax:
Practice Address - Street 1:6200 N CLARK ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60660-1208
Practice Address - Country:US
Practice Address - Phone:773-743-1221
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-26
Last Update Date:2016-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046.008419152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILIL1535Medicare PIN
ILU98420Medicare UPIN