# CHICAGO RETINA, INCORPORATED

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1619129491
- **Authorized official:** DR. CAROL A MENNER M.D. (PRESIDENT)
- **Authorized official phone:** (773) 394-6990

## Contact information

- **Practice address:** 1182 N MILWAUKEE AVE, STOREFRONT, CHICAGO, IL 60642-4007
- **Practice address phone:** (773) 394-6990
- **Practice address fax:** (773) 394-6993
- **Mailing address:** 1182 N MILWAUKEE AVE, STOREFRONT, CHICAGO, IL 60642-4007
- **Mailing address phone:** (773) 394-6990
- **Mailing address fax:** (773) 394-6993

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207W00000X | Ophthalmology Physician | 036097549 | IL | Yes |

## Other

- **Enumeration date:** 10/11/2008
- **Last updated:** 10/11/2008