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Organization

CRYSTAL LAKE OPHTHALMOLOGY ASSOCIATES PC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
EDWARD GEO DOLEZAL MD (PHYSICIAN OWNER)
(815) 455-4222
Entity
Organization

Contact information

Practice address
280A MEMORIAL CT, 280A MEMORIAL CT, CRYSTAL LAKE, IL 60014-6233
(815) 455-4222
(815) 455-5093
Mailing address
280A MEMORIAL CT, CRYSTAL LAKE, IL 60014-6233
(815) 455-4222
(815) 455-5093

Taxonomy

Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
036070162
IL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
036070162
IL
01
180038854
RAILROAD MEDICARE
Enumeration date
12/04/2006
Last updated
02/28/2011
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