# CRYSTAL LAKE OPHTHALMOLOGY ASSOCIATES PC

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

## Provider details

- **NPI number:** 1669530838
- **Authorized official:** EDWARD GEO DOLEZAL MD (PHYSICIAN OWNER)
- **Authorized official phone:** (815) 455-4222

## Contact information

- **Practice address:** 280A MEMORIAL CT, 280A MEMORIAL CT, CRYSTAL LAKE, IL 60014-6233
- **Practice address phone:** (815) 455-4222
- **Practice address fax:** (815) 455-5093
- **Mailing address:** 280A MEMORIAL CT, CRYSTAL LAKE, IL 60014-6233
- **Mailing address phone:** (815) 455-4222
- **Mailing address fax:** (815) 455-5093

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207W00000X | Ophthalmology Physician | 036070162 | IL | Yes |

## Other

- **Enumeration date:** 12/04/2006
- **Last updated:** 02/28/2011

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 036070162 | — | IL |
| 01 | — | 180038854 | RAILROAD MEDICARE | — |