Provider Demographics
NPI:1649323502
Name:RITACCA LASER CENTER
Entity type:Organization
Organization Name:RITACCA LASER CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPHTHALMOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:RITACCA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-367-8815
Mailing Address - Street 1:230 CENTER DRIVE
Mailing Address - Street 2:
Mailing Address - City:VERNON HILLS
Mailing Address - State:IL
Mailing Address - Zip Code:60061
Mailing Address - Country:US
Mailing Address - Phone:847-367-8815
Mailing Address - Fax:847-367-8819
Practice Address - Street 1:230 CENTER DR
Practice Address - Street 2:
Practice Address - City:VERNON HILLS
Practice Address - State:IL
Practice Address - Zip Code:60061-1584
Practice Address - Country:US
Practice Address - Phone:847-367-8815
Practice Address - Fax:847-367-8819
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2086S0122X152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILB95525Medicare UPIN