| NPI | 1750765012 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARY FREDERICK Billing Manager 708-915-6963 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM2500X Clinic/Center Medical Specialty |
| Additional Taxonomies | 261Q00000X Clinic/Center |
| 261QS0132X Clinic/Center Ophthalmologic Surgery | |
| Enumeration Date | 2015-07-16 |
| Last Update Date | 2017-11-15 |