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Contact Information

CRYSTAL LAKE OPHTHALMOLOGY ASSOCIATES PC
280A MEMORIAL CT
280A MEMORIAL CT
CRYSTAL LAKE, IL60014-6233
 Phone: 815-455-4222
 Fax: 815-455-5093
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Ophthalmology

207W00000X 18 Physician/Ophthalmology
Indicates primary specialty

NPI Profile & details for CRYSTAL LAKE OPHTHALMOLOGY ASSOCIATES PC · (Female)

NPI # 1669530838
Status Active
Credentials
Entity Individual
Enumeration date 12/04/2006
Last updated 02/28/2011 - About 15 years ago
Sole proprietor 1 Not specified
Identifiers
  • IL License # 036070162
  • IL Medicaid 036070162
  • Other 180038854 RAILROAD MEDICARE
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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