Provider Demographics
NPI:1750526760
Name:RITACCA LASER CENTER
Entity type:Organization
Organization Name:RITACCA LASER CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DAN
Authorized Official - Middle Name:
Authorized Official - Last Name:RITACCA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-367-8815
Mailing Address - Street 1:230 CENTER DR
Mailing Address - Street 2:
Mailing Address - City:VERNON HILLS
Mailing Address - State:IL
Mailing Address - Zip Code:60061-1584
Mailing Address - Country:US
Mailing Address - Phone:847-367-8815
Mailing Address - Fax:866-367-8319
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:866-367-8319
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RITACCA LASERCENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-12-04
Last Update Date:2008-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical