Provider Demographics
NPI:1780723403
Name:CHICAGO EYE INSTITUTE, PLLC
Entity type:Organization
Organization Name:CHICAGO EYE INSTITUTE, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:INSURANCE SUPERVISOR
Authorized Official - Prefix:MS
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:T
Authorized Official - Last Name:VEREST
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-282-2000
Mailing Address - Street 1:5086 N ELSTON AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60630-2427
Mailing Address - Country:US
Mailing Address - Phone:773-282-2000
Mailing Address - Fax:773-282-9428
Practice Address - Street 1:5086 N ELSTON AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60630-2427
Practice Address - Country:US
Practice Address - Phone:773-282-2000
Practice Address - Fax:773-282-9428
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-06
Last Update Date:2021-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL695254OtherPTAN