Provider Demographics
NPI:1760558464
Name:MILWAUKEE AVENUE EYE CENTER, S.C.
Entity type:Organization
Organization Name:MILWAUKEE AVENUE EYE CENTER, S.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JENNY
Authorized Official - Middle Name:
Authorized Official - Last Name:NGO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-775-0811
Mailing Address - Street 1:7421 N MILWAUKEE AVE
Mailing Address - Street 2:
Mailing Address - City:NILES
Mailing Address - State:IL
Mailing Address - Zip Code:60714-3707
Mailing Address - Country:US
Mailing Address - Phone:773-775-0811
Mailing Address - Fax:773-819-7013
Practice Address - Street 1:7421 N MILWAUKEE AVE
Practice Address - Street 2:
Practice Address - City:NILES
Practice Address - State:IL
Practice Address - Zip Code:60714-3707
Practice Address - Country:US
Practice Address - Phone:773-775-0811
Practice Address - Fax:773-819-7013
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-27
Last Update Date:2025-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1760558464Medicaid
IL0001602167OtherBCBS
ILCC0518OtherMEDICARE RAILROAD
IL=========Medicaid
ILCC0518OtherMEDICARE RAILROAD
IL=========Medicaid