Provider Demographics
NPI:1568647220
Name:CHARLES S OVITSKY PC
Entity type:Organization
Organization Name:CHARLES S OVITSKY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:S
Authorized Official - Last Name:OVITSKY
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:773-588-3090
Mailing Address - Street 1:3500 W PETERSON AVE
Mailing Address - Street 2:SUITE 401
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60659-3306
Mailing Address - Country:US
Mailing Address - Phone:773-588-3090
Mailing Address - Fax:773-588-3210
Practice Address - Street 1:3500 W PETERSON AVE
Practice Address - Street 2:SUITE 401
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60659-3306
Practice Address - Country:US
Practice Address - Phone:773-588-3090
Practice Address - Fax:773-588-3210
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-31
Last Update Date:2022-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1603342OtherBLUE CROSS & BLUE SHIELD
ILIL7058Medicare PIN
IL1603342OtherBLUE CROSS & BLUE SHIELD
6635630001Medicare NSC
ILIL7059Medicare PIN
ILIL7061Medicare PIN