Provider Demographics
NPI:1215101845
Name:LEBOYER, RUSSELL MARCUS (MD,)
Entity type:Individual
Prefix:
First Name:RUSSELL
Middle Name:MARCUS
Last Name:LEBOYER
Suffix:
Gender:M
Credentials:MD,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9630 KENTON AVENUE EYE CARE LTD.
Mailing Address - Street 2:EYE CARE LTD.
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60076
Mailing Address - Country:US
Mailing Address - Phone:847-677-1631
Mailing Address - Fax:
Practice Address - Street 1:9630 KENTON AVENUE EYE CARE LTD.
Practice Address - Street 2:EYE CARE LTD.
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60076
Practice Address - Country:US
Practice Address - Phone:847-677-1631
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-15
Last Update Date:2021-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301091704207W00000X
IN01062131A207W00000X
IL036123252207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL362808633OtherTIN
IL577760002Medicare PIN
IL362808633OtherTIN