Organization
NORTHWESTERN MEDICAL FACULTY FOUNDATION
Active
Other names
Northwestern Medical Group
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JUSTIN A. JOHNSON (VP, CFO)
(312) 926-1599
Entity
Organization
Contact information
Practice address
259 E. ERIE STREET, SUITE#02-220, CHICAGO, IL 60611-2661
(312) 695-8150
Mailing address
680 N LAKE SHORE DR, SUITE#1000, CHICAGO, IL 60611-4546
(312) 695-9797
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
—
—
152WC0802X
Corneal and Contact Management Optometrist
—
—
152WV0400X
Vision Therapy Optometrist
—
—
Other
Enumeration date
08/15/2014
Last updated
08/15/2014
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