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Organization
CRYSTAL LAKE OPHTHALMOLOGY ASSOCIATES PC
Active
Organization
CRYSTAL LAKE OPHTHALMOLOGY ASSOCIATES PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
EDWARD GEO DOLEZAL MD (PHYSICIAN OWNER)
(815) 455-4222
Entity
Organization
Contact information
Practice address
280A MEMORIAL CT, 280A MEMORIAL CT, CRYSTAL LAKE, IL 60014-6233
(815) 455-4222
(815) 455-5093
Mailing address
280A MEMORIAL CT, CRYSTAL LAKE, IL 60014-6233
(815) 455-4222
(815) 455-5093
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
036070162
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036070162
—
IL
01
—
180038854
RAILROAD MEDICARE
—
Enumeration date
12/04/2006
Last updated
02/28/2011
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