Organization
ILLINOIS RETINA ASSOCIATES, S.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARY FREDERICK (BILLING MANAGER)
(708) 915-6963
Entity
Organization
Contact information
Practice address
71 W 156TH ST STE 400, HARVEY, IL 60426-4265
(708) 596-8710
Mailing address
71 W 156TH ST STE 400, HARVEY, IL 60426-4265
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
—
—
261QM2500X
Medical Specialty Clinic/Center
Primary
—
—
261QS0132X
Ophthalmologic Surgery Clinic/Center
—
—
Other
Enumeration date
07/16/2015
Last updated
11/15/2017
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