Provider Demographics
NPI:1669150728
Name:MEDICAL ARTS CLINIC LLC
Entity type:Organization
Organization Name:MEDICAL ARTS CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ANAPLASTOLOGIST /OCULARIST
Authorized Official - Prefix:
Authorized Official - First Name:EDUARDO
Authorized Official - Middle Name:
Authorized Official - Last Name:ARIAS AMEZQUITA
Authorized Official - Suffix:
Authorized Official - Credentials:CCA
Authorized Official - Phone:832-725-5664
Mailing Address - Street 1:620 N LA SALLE DR STE 625
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60654-3708
Mailing Address - Country:US
Mailing Address - Phone:832-725-5664
Mailing Address - Fax:
Practice Address - Street 1:620 N LA SALLE DR STE 625
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60654-3708
Practice Address - Country:US
Practice Address - Phone:832-725-5664
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-10
Last Update Date:2025-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes229N00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersAnaplastologistGroup - Single Specialty
No156FX1700XEye and Vision Services ProvidersTechnician/TechnologistOcularistGroup - Single Specialty