Basic Information
| Provider Information | |||||||||
| NPI: | 1720187685 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | REIFF | ||||||||
| FirstName: | WILLIAM | ||||||||
| MiddleName: | M | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1435 N RANDALL RD | ||||||||
| Address2: | SUITE 102 | ||||||||
| City: | ELGIN | ||||||||
| State: | IL | ||||||||
| PostalCode: | 601232306 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8478418866 | ||||||||
| FaxNumber: | 8478418986 | ||||||||
| Practice Location | |||||||||
| Address1: | 1435 N RANDALL RD | ||||||||
| Address2: | SUITE 102 | ||||||||
| City: | ELGIN | ||||||||
| State: | IL | ||||||||
| PostalCode: | 601232306 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8478418866 | ||||||||
| FaxNumber: | 8478418986 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/21/2006 | ||||||||
| LastUpdateDate: | 01/07/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207W00000X | 036052088 | IL | Y | Allopathic & Osteopathic Physicians | Ophthalmology |
ID Information
| ID | Type | State | Issuer | Description | 036052088 | 05 | IL | MEDICAID |