Organization
ILLINOIS RETINA ASSOCIATES PLLC
Active
Other names
The Retina Center
Organization subpart
No
Provider details
NPI number
Authorized official
MARY FREDERICK (BILLING MANAGER)
(708) 915-6963
Entity
Organization
Contact information
Practice address
11516 183RD PL STE SW, ORLAND PARK, IL 60467-9471
(708) 877-1300
Mailing address
11516 183RD PL STE SW, ORLAND PARK, IL 60467-9471
(708) 877-1300
(708) 596-8719
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
036113707
IL
207WX0107X
Retina Specialist (Ophthalmology) Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CN0205
RAILROAD MEDICARE
IN
01
—
CN1137
RAILROAD MEDICARE
IL
Enumeration date
07/26/2005
Last updated
02/04/2026
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