Provider Demographics
NPI:1871620609
Name:OPHTHALMOLOGY NORTHWEST, S.C.
Entity type:Organization
Organization Name:OPHTHALMOLOGY NORTHWEST, S.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BOARD CERTIFIED OPHTHALMOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:B
Authorized Official - Last Name:BELLO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:773-775-9755
Mailing Address - Street 1:7447 W TALCOTT AVE
Mailing Address - Street 2:SUITE 406
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60631-3715
Mailing Address - Country:US
Mailing Address - Phone:773-775-9755
Mailing Address - Fax:773-775-4306
Practice Address - Street 1:7447 W TALCOTT AVE
Practice Address - Street 2:SUITE 406
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60631-3715
Practice Address - Country:US
Practice Address - Phone:773-775-9755
Practice Address - Fax:773-775-4306
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-28
Last Update Date:2009-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-062534207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL180005988OtherRAILROAD MEDICARE
IL31602843OtherBLUE CROSS & BLUE SHIELD
IL180005988OtherRAILROAD MEDICARE
ILC44349Medicare UPIN
IL789980Medicare PIN