# LEONID AYZENBERG, M.D. INC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Eye Clinic Leonid Ayzenberg MD INC
- **Organization subpart:** No

## Provider details

- **NPI number:** 1235294398
- **Authorized official:** LEONID AYZENBERG (PRESIDENT/OWNER)
- **Authorized official phone:** (847) 537-6800

## Contact information

- **Practice address:** 303 E. RAND RD, MT PROSPECT, IL 60056-1508
- **Practice address phone:** (847) 537-6800
- **Practice address fax:** (847) 556-8847
- **Mailing address:** 303 E. RAND RD, MT PROSPECT, IL 60056-1508
- **Mailing address phone:** (847) 537-6800
- **Mailing address fax:** (847) 556-8847

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207W00000X | Ophthalmology Physician | — | NULL | Yes |
| 207W00000X | Ophthalmology Physician | — | — | Yes |

## Other

- **Enumeration date:** 12/27/2006
- **Last updated:** 04/26/2022

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 036095153 | — | IL |
| 01 | — | 1622332 | BS & BS PROVIDER NUMBER | IL |
| 01 | — | ========= | TAX ID | IL |