1013342401 NPI number — NORTH SHORE EYE AND VASCULAR SC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013342401 NPI number — NORTH SHORE EYE AND VASCULAR SC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NORTH SHORE EYE AND VASCULAR SC
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:
1013342401
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/05/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
236 E IRVING PARK RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WOOD DALE
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60191-2099
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
847-590-1500
Provider Business Mailing Address Fax Number:
847-590-1502

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
236 E IRVING PARK RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WOOD DALE
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60191-2099
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
847-590-1500
Provider Business Practice Location Address Fax Number:
847-590-1502
Provider Enumeration Date:
09/05/2013

Additional Information

Authorized Official

Authorized Official Last Name:
TOLITANO
Authorized Official First Name:
DOMINIC
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
847-590-1500

Provider Taxonomy Codes

  • Taxonomy code: 2086S0129X , with the licence number:  036067328 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207W00000X , with the licence number: 036049793 , 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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