Provider Demographics
NPI:1285875823
Name:EYE SEE RAVENSWOOD, PC
Entity type:Organization
Organization Name:EYE SEE RAVENSWOOD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:J
Authorized Official - Last Name:STEIN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:773-961-8700
Mailing Address - Street 1:4735 NORTH DAMEN AVE
Mailing Address - Street 2:EYE SEE RAVENSWOOD, PC
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60640
Mailing Address - Country:US
Mailing Address - Phone:773-961-8700
Mailing Address - Fax:773-961-8703
Practice Address - Street 1:4735 NORTH DAMEN AVE
Practice Address - Street 2:EYE SEE RAVENSWOOD, PC
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60640
Practice Address - Country:US
Practice Address - Phone:773-961-8700
Practice Address - Fax:773-961-8703
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-11
Last Update Date:2009-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046009834152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1205388193OtherNPI