Organization
LAKESIDE EYE CLINIC INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ERNESTO CARRASCO (PRESIDENT)
(312) 553-1818
Entity
Organization
Contact information
Practice address
104 S MICHIGAN AVE, 410, CHICAGO, IL 60603-5902
(312) 553-1818
(312) 641-5503
Mailing address
104 S MICHIGAN AVE, 410, CHICAGO, IL 60603-5902
(312) 553-1818
(312) 641-5503
Taxonomy
Speciality
Code
Description
License number
State
305R00000X
Preferred Provider Organization
Primary
—
IL
Other
Enumeration date
05/30/2007
Last updated
08/22/2020
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