1144288689 NPI number — VISION SURGEONS AND CONSULTANTS, LTD

Table of content: (NPI 1144288689)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144288689 NPI number — VISION SURGEONS AND CONSULTANTS, LTD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VISION SURGEONS AND CONSULTANTS, LTD
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1144288689
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/21/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5501 W 79TH ST
Provider Second Line Business Mailing Address:
SUITE 400
Provider Business Mailing Address City Name:
BURBANK
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60459-1784
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
773-884-4523
Provider Business Mailing Address Fax Number:
773-884-4580

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
800 AUSTIN ST
Provider Second Line Business Practice Location Address:
EAST TOWER STE 151
Provider Business Practice Location Address City Name:
EVANSTON
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60202-3439
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
847-328-2300
Provider Business Practice Location Address Fax Number:
847-492-1988
Provider Enumeration Date:
05/03/2006

Additional Information

Authorized Official

Authorized Official Last Name:
GOLDEN-BRENNER
Authorized Official First Name:
CARRIE
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
847-328-2300

Provider Taxonomy Codes

  • Taxonomy code: 208600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 01623637 . This is a "BLUE SHIELD" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".




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