Provider Demographics
NPI:1720110497
Name:RITACCA LASER CENTER LTD
Entity Type:Organization
Organization Name:RITACCA LASER CENTER LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:JOHN
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, SUITE 101
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:2007-03-09
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL261QM1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036061443Medicaid
ILB95525Medicare UPIN