NPIMap

Organization Active NPI

Suburban Medical Aesthetics, PLLC

  • Ophthalmic Plastic and Reconstructive Surgery Physician
  • Evanston, IL
National Provider Identifier
1922781673
Registry record updated Aug 9, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ophthalmic Plastic and Reconstructive Surgery PhysicianTaxonomy code 207WX0200X
Legal business name
SUBURBAN MEDICAL AESTHETICS, PLLC
Practice address
500 Davis St Ste 810
Evanston, IL 60201-4655
Phone
(847) 424-1100
Fax
(847) 448-0201
NPI assigned
Aug 9, 2023
Organization subpart
Yes
Parent organization
SUBURBAN EYES CLINIC, LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Aug 9, 2023

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

Authorized official

Name
Dr. Phillip C. Wu, M.D.
Title
Physician Owner
Phone
(847) 424-1100

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Ophthalmology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207W00000X
Cornea and External Diseases Specialist PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207WX0120X
Ophthalmic Plastic and Reconstructive Surgery PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207WX0200X Primary

Addresses

Primary practice location

500 Davis St Ste 810
Evanston, IL 60201-4655

Mailing address

500 Davis St Ste 810
Evanston, IL 60201-4655
Phone (847) 424-1100

National Provider Directory

National Provider Directory
Part of
Suburban Eyes Clinic LLC

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

NPI Registry JSON

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

{
    "created_epoch": "1691539200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1691539200000",
    "number": "1922781673",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "500 DAVIS ST STE 810",
            "city": "EVANSTON",
            "state": "IL",
            "postal_code": "602014655",
            "telephone_number": "847-424-1100",
            "fax_number": "847-448-0201"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 DAVIS ST STE 810",
            "city": "EVANSTON",
            "state": "IL",
            "postal_code": "602014655",
            "telephone_number": "847-424-1100",
            "fax_number": "847-448-0201"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUBURBAN MEDICAL AESTHETICS, PLLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SUBURBAN EYES CLINIC, LLC",
        "enumeration_date": "2023-08-09",
        "last_updated": "2023-08-09",
        "certification_date": "2023-08-09",
        "status": "A",
        "authorized_official_last_name": "WU",
        "authorized_official_first_name": "PHILLIP",
        "authorized_official_middle_name": "C.",
        "authorized_official_title_or_position": "PHYSICIAN OWNER",
        "authorized_official_telephone_number": "847-424-1100",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Ophthalmology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207WX0120X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Ophthalmology, Cornea and External Diseases Specialist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207WX0200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Ophthalmology, Ophthalmic Plastic and Reconstructive Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Evanston, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 9, 2023; 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.