Provider Demographics
NPI:1871772111
Name:MODERN EYE CAER LTD
Entity type:Organization
Organization Name:MODERN EYE CAER LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:ALEKSANDR
Authorized Official - Middle Name:
Authorized Official - Last Name:KAGAN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:773-564-6175
Mailing Address - Street 1:4640 N MARINE DR
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60640-5719
Mailing Address - Country:US
Mailing Address - Phone:773-564-6175
Mailing Address - Fax:773-561-0631
Practice Address - Street 1:4640 N MARINE DR
Practice Address - Street 2:8 BLUM
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60640-5719
Practice Address - Country:US
Practice Address - Phone:773-564-6175
Practice Address - Fax:773-561-0631
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-02
Last Update Date:2007-12-20
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
1598728453OtherINDIVIDUAL NPI
1598728453OtherINDIVIDUAL NPI