1083684922 NPI number — THE EYE SPECIALISTS CENTER LLC

Table of content: (NPI 1083684922)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1083684922 NPI number — THE EYE SPECIALISTS CENTER LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THE EYE SPECIALISTS CENTER LLC
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:
6
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:
1083684922
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/23/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
DEPARTMENT 4684
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CAROL STREAM
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60122-4684
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
708-952-0329
Provider Business Mailing Address Fax Number:
708-952-0329

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10436 SOUTHWEST HWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHICAGO RIDGE
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60415-2282
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
708-423-4070
Provider Business Practice Location Address Fax Number:
708-423-4216
Provider Enumeration Date:
01/24/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BUKA
Authorized Official First Name:
JONATHAN
Authorized Official Middle Name:
S
Authorized Official Title or Position:
OWNER/PARTNER/PHYSICIAN
Authorized Official Telephone Number:
708-423-4070

Provider Taxonomy Codes

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

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

  • Identifier: 036128553 , issued by the state of ( IL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1679551014 . This is a "NPI INDIVIDUAL" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 180046211 . This is a "MEDICARE RAILROAD" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 046009799 . This is a "LICENSE NO" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 047935429 , issued by the state of ( IL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1700047222 . This is a "NPI INDIVIDUAL KABITA S SHIFRIN, DO" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 1770544462 . This is a "NPI INDIVIDUAL EMMET M. CASSIDY, MD" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 036123095 , issued by the state of ( IL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 047935428 , issued by the state of ( IL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1477522050 . This is a "NPI INDIVIDUAL JONATHAN S BUKA, MD" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 1992782494 . This is a "NPI INDIVIDUAL BENJAMIN H TICHO" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 253350 . This is a "PTAN INDIANA MEDICARE GROUP" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: CK7818 . This is a "MEDICARE RAILROAD GRP PTAN" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 1659412682 . This is a "NPI INDIVIDUAL HASSAN A SHAH, MD" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 1689988446 . This is a "NPI INDIVIDUAL CHRISTINA M TWARDOWSKI, OD" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 1700047222 . This is a "NPI DR SHIFRIN" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 180046209 . This is a "MEDICARE RAILROAD" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: PTAN P00638025 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 12324832 . This is a "CAQH R. VASAIWALA, MD" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 1386637791 . This is a "INDIVIDUAL NPI" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".




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