Organization
OPHTHALMOLOGY SURGERY CENTER OF ILLINOIS, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KEVIN J KOVACH MD (PRESIDENT)
(630) 634-2980
Entity
Organization
Contact information
Practice address
1300 N ARLINGTON HEIGHTS RD STE 150, ITASCA, IL 60143-3128
(630) 634-2980
(630) 625-8116
Mailing address
1300 N ARLINGTON HEIGHTS RD STE 150, ITASCA, IL 60143-3128
(630) 634-2980
(630) 625-8116
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
248002884
AMBULATORY SURGICAL CENTER LICENSE
IL
Enumeration date
06/06/2019
Last updated
08/03/2021
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