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 | 261QS0132X Clinic/Center, Ophthalmologic Surgery |
261Q00000X Clinic/Center | |
Enumeration Date | 2015-07-16 |
Last Update Date | 2017-11-15 |