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
Update your record
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