Provider Demographics
NPI:1538369574
Name:WHISPERING POINT OPHTHALMOLOGY SC
Entity type:Organization
Organization Name:WHISPERING POINT OPHTHALMOLOGY SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KIM
Authorized Official - Middle Name:
Authorized Official - Last Name:ZAWACKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:815-363-8866
Mailing Address - Street 1:4314 W CRYSTAL LAKE RD STE B
Mailing Address - Street 2:
Mailing Address - City:MCHENRY
Mailing Address - State:IL
Mailing Address - Zip Code:60050-4281
Mailing Address - Country:US
Mailing Address - Phone:815-363-8866
Mailing Address - Fax:815-363-8893
Practice Address - Street 1:4314 W CRYSTAL LAKE RD STE B
Practice Address - Street 2:
Practice Address - City:MCHENRY
Practice Address - State:IL
Practice Address - Zip Code:60050-4281
Practice Address - Country:US
Practice Address - Phone:815-363-8866
Practice Address - Fax:815-363-8893
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-18
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036097592174400000X
IL0174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL05600304OtherBLUE CROSS BLUE SHEILD PI
IL0360825434Medicaid
IL4558723OtherAETNA PIN
IL604367OtherUNITED HEALTH CARE PIN
IL05600304OtherBLUE CROSS BLUE SHEILD PI