Organization
LAKESIDE EYE GROUP, S.C.
Active
Other names
Taub Eye Center, s.c
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SANJAY N RAO MD (OPHTHALMOLOGIST)
(312) 553-1818
Entity
Organization
Contact information
Practice address
180 N MICHIGAN AVE, SUITE 1900, CHICAGO, IL 60601-7401
(312) 553-1818
(312) 641-5503
Mailing address
180 N MICHIGAN AVE, SUITE 1900, CHICAGO, IL 60601-7401
(312) 553-1818
(312) 641-5503
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
042007938
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036102488
—
IL
01
—
31601613
BLUE CROSS BLUE SHIELD OF
IL
01
—
369060
GROUP NUMBER FOR MEDICARE
IL
Enumeration date
07/16/2007
Last updated
07/22/2013
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