Provider Demographics
NPI:1538730668
Name:THOMAS D PATRIANAKOS NORTHWEST CHICAGO EYE SPECIALISTS
Entity type:Organization
Organization Name:THOMAS D PATRIANAKOS NORTHWEST CHICAGO EYE SPECIALISTS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:PATRIANAKOS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:773-792-2020
Mailing Address - Street 1:5872 N MILWAUKEE AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60646-5425
Mailing Address - Country:US
Mailing Address - Phone:773-792-2020
Mailing Address - Fax:
Practice Address - Street 1:5872 N MILWAUKEE AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60646-5425
Practice Address - Country:US
Practice Address - Phone:773-792-2020
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-09
Last Update Date:2021-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
No204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial SurgeryGroup - Multi-Specialty