Organization
ST. JOSEPH HOSPITAL
Active
Other names
SJH Pediatric Opthalmology
Organization subpart
No
Provider details
NPI number
Authorized official
MR. RONALD E STRUXNESS (CHIEF EXECUTIVE OFFICER)
(773) 665-3000
Entity
Organization
Contact information
Practice address
2900 N LAKE SHORE DR., CHICAGO, IL 60657
(773) 665-3000
Mailing address
1 TRANSAM PLAZA DR., SUITE 490, OAKBROOK TERRACE, IL 60181
(630) 424-1122
(630) 424-1678
Taxonomy
Speciality
Code
Description
License number
State
152WP0200X
Pediatric Optometrist
Primary
036074319
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01632129
BCBS OF IL GROUP PROVIDER
IL
Enumeration date
05/09/2007
Last updated
08/04/2008
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