# EYE SPECIALIST GROUP, LLC

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

## Provider details

- **NPI number:** 1669945440
- **Authorized official:** CARRIE VIOLETTO (PRACTICE MANAGER)
- **Authorized official phone:** (708) 307-0217

## Contact information

- **Practice address:** 4400 W 95TH ST STE 312, OAK LAWN, IL 60453-2660
- **Practice address phone:** (708) 307-0217
- **Mailing address:** 4400 W 95TH ST STE 312, OAK LAWN, IL 60453-2660
- **Mailing address phone:** (708) 307-0217

## Taxonomy

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

## Other

- **Enumeration date:** 01/04/2019
- **Last updated:** 01/04/2019

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 036066839 | PHYSICIAN LICENSE | IL |