Organization
EYE SPECIALIST GROUP, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CARRIE VIOLETTO (PRACTICE MANAGER)
(708) 307-0217
Entity
Organization
Contact information
Practice address
4400 W 95TH ST STE 312, OAK LAWN, IL 60453-2660
(708) 307-0217
Mailing address
4400 W 95TH ST STE 312, OAK LAWN, IL 60453-2660
(708) 307-0217
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
036066839
PHYSICIAN LICENSE
IL
Enumeration date
01/04/2019
Last updated
01/04/2019
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