Provider Demographics
NPI:1730377011
Name:FAGMAN EYE SURGERY ASSOCIATES
Entity type:Organization
Organization Name:FAGMAN EYE SURGERY ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:SAMUEL
Authorized Official - Last Name:FAGMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-675-2001
Mailing Address - Street 1:4711 GOLF RD
Mailing Address - Street 2:SUITE 525
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60076-1224
Mailing Address - Country:US
Mailing Address - Phone:847-675-2001
Mailing Address - Fax:847-675-2006
Practice Address - Street 1:4711 GOLF RD
Practice Address - Street 2:SUITE 525
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60076-1224
Practice Address - Country:US
Practice Address - Phone:847-675-2001
Practice Address - Fax:847-675-2006
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-11
Last Update Date:2007-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILC38820Medicare UPIN
IL211065Medicare PIN