# ILLINOIS RETINA ASSOCIATES, S.C.

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

## Provider details

- **NPI number:** 1750765012
- **Authorized official:** MARY FREDERICK (BILLING MANAGER)
- **Authorized official phone:** (708) 915-6963

## Contact information

- **Practice address:** 71 W 156TH ST STE 400, HARVEY, IL 60426-4265
- **Practice address phone:** (708) 596-8710
- **Mailing address:** 71 W 156TH ST STE 400, HARVEY, IL 60426-4265

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261Q00000X | Clinic/Center | — | NULL | — |
| 261QM2500X | Medical Specialty Clinic/Center | — | NULL | Yes |
| 261QS0132X | Ophthalmologic Surgery Clinic/Center | — | NULL | — |

## Other

- **Enumeration date:** 07/16/2015
- **Last updated:** 11/15/2017