Provider Demographics
NPI:1730252230
Name:FAMILY EYE PHYSICIANS, LTD
Entity type:Organization
Organization Name:FAMILY EYE PHYSICIANS, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MOHAMMAD
Authorized Official - Middle Name:
Authorized Official - Last Name:AL-KHUDARI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:708-636-9393
Mailing Address - Street 1:6201 W 95TH ST
Mailing Address - Street 2:
Mailing Address - City:OAK LAWN
Mailing Address - State:IL
Mailing Address - Zip Code:60453-2701
Mailing Address - Country:US
Mailing Address - Phone:708-636-9393
Mailing Address - Fax:708-636-2022
Practice Address - Street 1:6201 W 95TH ST
Practice Address - Street 2:
Practice Address - City:OAK LAWN
Practice Address - State:IL
Practice Address - Zip Code:60453-2701
Practice Address - Country:US
Practice Address - Phone:708-636-9393
Practice Address - Fax:708-636-2022
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-15
Last Update Date:2023-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046009744152W00000X
IL036103747207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
No152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL120602OtherADVOCATE HLTH PARTNERS ID
ILB0830165OtherEYEFINITY CLEARING HOUSE
IL0001633597OtherBCBS PROVIDER ID
IL125181500OtherUS DEPT OF LABOR
IL125181500OtherUS DEPT OF LABOR
IL=========-60453-01Medicaid
IL5757720001Medicare NSC
IL210631Medicare PIN
ILDC1735Medicare PIN
IL120602OtherADVOCATE HLTH PARTNERS ID