Provider Demographics
NPI:1366106775
Name:MIDWEST DRY EYE CENTER LLC
Entity type:Organization
Organization Name:MIDWEST DRY EYE CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OD/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TODD
Authorized Official - Middle Name:G
Authorized Official - Last Name:COHAN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:847-955-9393
Mailing Address - Street 1:4160 IL ROUTE 83 STE 107
Mailing Address - Street 2:
Mailing Address - City:LONG GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60047-8034
Mailing Address - Country:US
Mailing Address - Phone:847-955-9393
Mailing Address - Fax:847-955-9857
Practice Address - Street 1:7250 N CICERO AVE STE 120
Practice Address - Street 2:
Practice Address - City:LINCOLNWOOD
Practice Address - State:IL
Practice Address - Zip Code:60712-1627
Practice Address - Country:US
Practice Address - Phone:630-833-9621
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-22
Last Update Date:2021-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty