Organization
SUBURBAN EYE SPECIALISTS
Active
Other names
Ticho Eye Associates
Organization subpart
No
Provider details
NPI number
Authorized official
BENJAMIN TICHO MD (AUTHORIZED OFFICIAL/OWNER)
(708) 873-0088
Entity
Organization
Contact information
Practice address
10436 SOUTHWEST HWY STE 101, CHICAGO RIDGE, IL 60415-2282
(708) 586-4922
Mailing address
10436 SOUTHWEST HWY STE 101, CHICAGO RIDGE, IL 60415-2282
(708) 586-4922
Taxonomy
Speciality
Code
Description
License number
State
156FX1202X
Optometric Technician
—
—
207W00000X
Ophthalmology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
300016721
—
IN
05
—
300622839
—
IL
Enumeration date
09/20/2018
Last updated
10/07/2024
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