1225148448 NPI number — ASSOCIATED OPHTHALMOLOGISTS S C

Table of content: MS. LAUREN NICOLE ENGLISH AUD (NPI 1740727833)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225148448 NPI number — ASSOCIATED OPHTHALMOLOGISTS S C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ASSOCIATED OPHTHALMOLOGISTS S C
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:
1225148448
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/26/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
219 N HAMMES AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
JOLIET
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60435-8145
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
815-741-3220
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
219 N HAMMES AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JOLIET
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60435-8145
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
815-741-3220
Provider Business Practice Location Address Fax Number:
815-741-3814
Provider Enumeration Date:
08/30/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MORIMOTO
Authorized Official First Name:
DAVID
Authorized Official Middle Name:
D.
Authorized Official Title or Position:
PARTNER
Authorized Official Telephone Number:
815-741-3220

Provider Taxonomy Codes

  • Taxonomy code: 207W00000X , with the licence number:  042001040 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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