Lakeside Eye Clinic Inc

Primary specialty

Preferred Provider OrganizationTaxonomy code 305R00000X

Legal business name

LAKESIDE EYE CLINIC INC

Practice address

104 S Michigan Ave
410
Chicago, IL 60603-5902

Phone

(312) 553-1818

Fax

(312) 641-5503

NPI assigned

May 30, 2007

Last updated

Aug 22, 2020By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Ernesto Carrasco

Title

President

Phone

(312) 553-1818

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1180483200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1871794362",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "104 S MICHIGAN AVE",
            "address_2": "410",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606035902",
            "telephone_number": "312-553-1818",
            "fax_number": "312-641-5503"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "104 S MICHIGAN AVE",
            "address_2": "410",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606035902",
            "telephone_number": "312-553-1818",
            "fax_number": "312-641-5503"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKESIDE EYE CLINIC INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-30",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "CARRASCO",
        "authorized_official_first_name": "ERNESTO",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "312-553-1818",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "305R00000X",
            "taxonomy_group": "",
            "desc": "Preferred Provider Organization",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lakeside Community Committee
• Lakeside Community Committee
• Lakeside Dental Center
• Lakeside Dental Center
• Lakeside Dental Center Inc.
• Lakeside Eye Group, S.C.
• Lakeside Medical Group LTD
• Lakeside Nephrolgoy LTD/Prarie
• Lakeside Nephrology, LTD.
• Lakeside Nephrology, LTD.

• Preferred Provider Organization in Chicago, IL
• Providers in Chicago, IL by specialty
• Preferred Provider Organization in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.