Provider Demographics
NPI:1356601041
Name:ORLAND EYE, LTD
Entity type:Organization
Organization Name:ORLAND EYE, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GLORIA
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:DOCHERTY
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:708-650-2522
Mailing Address - Street 1:15410 S HARLEM AVE
Mailing Address - Street 2:
Mailing Address - City:ORLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60462-4333
Mailing Address - Country:US
Mailing Address - Phone:708-633-0011
Mailing Address - Fax:708-633-9111
Practice Address - Street 1:15410 S HARLEM AVE
Practice Address - Street 2:
Practice Address - City:ORLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60462-4333
Practice Address - Country:US
Practice Address - Phone:708-633-0011
Practice Address - Fax:708-633-9111
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-29
Last Update Date:2012-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046007647152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL7196Medicare PIN