Provider Demographics
NPI:1255354601
Name:WEST SUBURBAN EYE ASSOCIATES LLC
Entity type:Organization
Organization Name:WEST SUBURBAN EYE ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:S
Authorized Official - Last Name:SPRINGER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:708-848-2400
Mailing Address - Street 1:1 ERIE COURT
Mailing Address - Street 2:SUITE 6140
Mailing Address - City:OAK PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60302
Mailing Address - Country:US
Mailing Address - Phone:708-848-2400
Mailing Address - Fax:708-445-8269
Practice Address - Street 1:1 ERIE COURT
Practice Address - Street 2:SUITE 6140
Practice Address - City:OAK PARK
Practice Address - State:IL
Practice Address - Zip Code:60302
Practice Address - Country:US
Practice Address - Phone:708-848-2400
Practice Address - Fax:708-445-8269
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-26
Last Update Date:2008-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036070377207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILCN8734OtherRAILROAD MEDICARE
IL0031600193OtherBLUE SHIELD
ILCN8734OtherRAILROAD MEDICARE
IL0031600193OtherBLUE SHIELD