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Organization
NORTHEWESTERN OPTHALMIC INSTITUTE
Active
Organization
NORTHEWESTERN OPTHALMIC INSTITUTE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. THOMAS E BOURNIAS (DR)
(847) 832-3900
Entity
Organization
Contact information
Practice address
3633 WEST LAKE AVENUE, SUITE 104, GLENVIEW, IL 60026
(847) 832-3900
(847) 832-3904
Mailing address
3633 WEST LAKE AVENUE, SUITE 104, GLENVIEW, IL 60026
(847) 832-3900
(847) 832-3904
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
36093343
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036093343
—
IL
01
—
7797487
AETNA
IL
Enumeration date
12/11/2006
Last updated
03/15/2013
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