Organization
RETINA OF ILLINOIS, S.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. AASHISH V GANDHI M.D. (PRESIDENT)
(217) 898-7686
Entity
Organization
Contact information
Practice address
475 BROWN BLVD, SUITE 109, BOURBONNAIS, IL 60914-2325
(815) 802-2090
(815) 802-2093
Mailing address
475 BROWN BLVD, SUITE 109, BOURBONNAIS, IL 60914-2325
(815) 802-2090
(815) 802-2093
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1518989847
PHYSICIAN NPI- TYPE 1
—
Enumeration date
02/13/2007
Last updated
07/24/2007
Update your record
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