Organization
ILLINOIS COLLEGE OF OPTOMETRY
Active
Other names
Illinois Eye Institute
Organization subpart
No
Provider details
NPI number
Authorized official
MARK COLIP OD (PRESIDENT)
(312) 949-7701
Entity
Organization
Contact information
Practice address
3241 S MICHIGAN AVENUE, CHICAGO, IL 60616-3878
(312) 225-6200
(312) 949-7660
Mailing address
3241 S MICHIGAN AVENUE, CHICAGO, IL 60616-3878
(312) 225-6200
(312) 949-7660
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
—
—
332B00000X
Durable Medical Equipment & Medical Supplies
8720518
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
502720
MEDICARE PTAN
IL
01
—
CD4768
RAILROAD MEDICARE
IL
Enumeration date
01/09/2006
Last updated
01/08/2021
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