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Organization

SOUTHPORT EYE ASSOCIATES LTD

Active
Other names
Custom Eyes
Organization subpart
No

Provider details

NPI number
Authorized official
DR. MICHAEL SCULLEY OD (OPTOMETRIST)
(773) 871-2020
Entity
Organization

Contact information

Practice address
3539 N SOUTHPORT AVE, CHICAGO, IL 60657
(773) 871-2020
(773) 871-2099
Mailing address
3539 N SOUTHPORT AVE, CHICAGO, IL 60657-6447
(773) 871-2020
(773) 871-2099

Taxonomy

Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
046.009541
IL

Other

Enumeration date
08/28/2009
Last updated
05/24/2018
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