Individual
ERIK J MOTHERSBAUGH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
3241 S MICHIGAN AVE, CHICAGO, IL 60616-3878
(312) 225-6200
(312) 949-7389
Mailing address
3241 S MICHIGAN AVE, CHICAGO, IL 60616-3878
(312) 225-6200
(312) 949-7389
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
046010542
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
046010542
—
IL
01
—
502720058
MEDICARE PTAN
IL
Enumeration date
06/13/2012
Last updated
05/31/2013
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