Provider Demographics
NPI:1144288689
Name:VISION SURGEONS AND CONSULTANTS, LTD
Entity type:Organization
Organization Name:VISION SURGEONS AND CONSULTANTS, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CARRIE
Authorized Official - Middle Name:
Authorized Official - Last Name:GOLDEN-BRENNER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-328-2300
Mailing Address - Street 1:5501 W 79TH ST
Mailing Address - Street 2:SUITE 400
Mailing Address - City:BURBANK
Mailing Address - State:IL
Mailing Address - Zip Code:60459-1784
Mailing Address - Country:US
Mailing Address - Phone:773-884-4523
Mailing Address - Fax:773-884-4580
Practice Address - Street 1:800 AUSTIN ST
Practice Address - Street 2:EAST TOWER STE 151
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60202-3439
Practice Address - Country:US
Practice Address - Phone:847-328-2300
Practice Address - Fax:847-492-1988
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-03
Last Update Date:2014-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01623637OtherBLUE SHIELD
IL01623637OtherBLUE SHIELD