Basic Information
| Provider Information | |||||||||
| NPI: | 1225224165 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | DEMPSTER EYE CARE PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5901 DEMPSTER ST | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | MORTON GROVE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 600533014 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8474701115 | ||||||||
| FaxNumber: | 8474701141 | ||||||||
| Practice Location | |||||||||
| Address1: | 5901 DEMPSTER ST | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | MORTON GROVE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 600533014 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8474701115 | ||||||||
| FaxNumber: | 8474701141 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/24/2007 | ||||||||
| LastUpdateDate: | 04/25/2011 | ||||||||
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| AuthorizedOfficialLastName: | MA | ||||||||
| AuthorizedOfficialFirstName: | SUN | ||||||||
| AuthorizedOfficialMiddleName: | AE | ||||||||
| AuthorizedOfficialTitleorPosition: | OPTOMETRIST | ||||||||
| AuthorizedOfficialTelephone: | 8474701115 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | O.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | 046-008065 | IL | Y | 193400000X SINGLE SPECIALTY GROUP | Eye and Vision Services Providers | Optometrist |
No ID Information.