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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

NPI # 1669530838
LBN Legal business name CRYSTAL LAKE OPHTHALMOLOGY ASSOCIATES PC
Authorized official EDWARD DOLEZAL - (PHYSICIAN OWNER)
Entity Organization
Organization subpart 1 No
Enumeration date 12/04/2006
Last updated 02/28/2011 - About 15 years ago
Identifiers
IL License # 036070162
IL Medicaid 036070162
Other 180038854 RAILROAD MEDICARE
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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