# GREAT LAKES RETINA, PLLC

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

## Provider details

- **NPI number:** 1629878079
- **Authorized official:** DR. OMAR MOHAMED HASSAN MD (PHYSICIAN)
- **Authorized official phone:** (847) 551-0049

## Contact information

- **Practice address:** 3438 N OLD ARLINGTON HEIGHTS RD, ARLINGTON HEIGHTS, IL 60004-1552
- **Practice address phone:** (847) 551-0049
- **Practice address fax:** (847) 787-1657
- **Mailing address:** 3438 N OLD ARLINGTON HEIGHTS RD, ARLINGTON HEIGHTS, IL 60004-1552
- **Mailing address phone:** (847) 551-0049
- **Mailing address fax:** (847) 787-1657

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207W00000X | Ophthalmology Physician | — | NULL | Yes |
| 207W00000X | Ophthalmology Physician | — | — | Yes |
| 207WX0107X | Retina Specialist (Ophthalmology) Physician | — | NULL | — |
| 207WX0107X | Retina Specialist (Ophthalmology) Physician | — | — | — |

## Other

- **Enumeration date:** 03/15/2025
- **Last updated:** 03/15/2025