Provider Demographics
NPI:1932210887
Name:DUPAGE EYE ASSOCIATES S.C.
Entity type:Organization
Organization Name:DUPAGE EYE ASSOCIATES S.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:M.D.
Authorized Official - Prefix:DR
Authorized Official - First Name:MOTILAL
Authorized Official - Middle Name:
Authorized Official - Last Name:RAICHAND
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:630-971-8330
Mailing Address - Street 1:3825 HIGHLAND AVE
Mailing Address - Street 2:TOWER 1 SUITE 4 J
Mailing Address - City:DOWNERS GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60515-1552
Mailing Address - Country:US
Mailing Address - Phone:630-971-8330
Mailing Address - Fax:630-971-2338
Practice Address - Street 1:3825 HIGHLAND AVE
Practice Address - Street 2:TOWER 1 SUITE 4 J
Practice Address - City:DOWNERS GROVE
Practice Address - State:IL
Practice Address - Zip Code:60515-1552
Practice Address - Country:US
Practice Address - Phone:630-971-8330
Practice Address - Fax:630-971-2338
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2012-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036056099174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL345601745Medicaid
IL358724500Medicaid
ILC43001Medicare UPIN
IL345601745Medicaid
ILH81881Medicare UPIN
IL659063Medicare ID - Type Unspecified