Provider Demographics
NPI:1699802421
Name:THE EYE SPECIALISTS CENTER, L.L.C.
Entity type:Organization
Organization Name:THE EYE SPECIALISTS CENTER, L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PARTNER/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:HENDRICK
Authorized Official - Last Name:TICHO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:708-423-4070
Mailing Address - Street 1:DEPARTMENT 4684
Mailing Address - Street 2:
Mailing Address - City:CAROL STREAM
Mailing Address - State:IL
Mailing Address - Zip Code:60122-4684
Mailing Address - Country:US
Mailing Address - Phone:708-952-0109
Mailing Address - Fax:708-952-0329
Practice Address - Street 1:10436 SOUTHWEST HWY
Practice Address - Street 2:
Practice Address - City:CHICAGO RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60415-2282
Practice Address - Country:US
Practice Address - Phone:708-423-4070
Practice Address - Fax:708-423-4216
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-28
Last Update Date:2013-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL156FX1202X
207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
No156FX1202XEye and Vision Services ProvidersTechnician/TechnologistOptometric TechnicianGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1134481211OtherNPI BIRVA KADAKIA, OD
IL1437323896OtherNPI ROSHNI VASAIWALA, MD
IL1477522050OtherNPI JONATHAN S BUKA, MD
IL1659412682OtherNPI HASSAN SHAH, MD
IL1881759694OtherNPI KARL TICHO, MD
IL1649256512OtherNPI ALEXANDER J KHAMMAR, MD
IL1306045083OtherNPI MEGAN ALLEN, OD
IL1770544462OtherNPI EMMET MICHAEL CASSIDY
IL1992782494OtherNPI BEN TICHO, MD
IL1770544462OtherNPI EMMET MICHAEL CASSIDY