Provider Demographics
NPI:1750423463
Name:OPHTHALMOLOGY PARTNERS, LTD.
Entity type:Organization
Organization Name:OPHTHALMOLOGY PARTNERS, LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:A
Authorized Official - Last Name:MAEHL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-945-6770
Mailing Address - Street 1:740 WAUKEGAN RD
Mailing Address - Street 2:SUITE 360
Mailing Address - City:DEERFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60015-4374
Mailing Address - Country:US
Mailing Address - Phone:847-945-6770
Mailing Address - Fax:847-945-3159
Practice Address - Street 1:740 WAUKEGAN RD
Practice Address - Street 2:SUITE 360
Practice Address - City:DEERFIELD
Practice Address - State:IL
Practice Address - Zip Code:60015-4374
Practice Address - Country:US
Practice Address - Phone:847-945-6770
Practice Address - Fax:847-945-3159
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-12
Last Update Date:2008-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CG8300OtherRAILROAD MEDICARE
CG8300OtherRAILROAD MEDICARE
IL1232050001Medicare NSC