LAKE SHORE RETINA, S. C. (NPI# 1255564258) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1255564258 |
| Entity Type | Organization |
| Organization Name | LAKE SHORE RETINA, S. C. |
| Practice Address |
850 W Irving Park Rd Chicago IL 60613-3077 |
| Mailing Address |
Po Box 10616 Chicago IL 60610-0616 |
| Practice Telephone | 7736772962 |
| Enumeration Date | 2009-08-25 |
| Last Update Date | 2009-08-25 |
| Authorized Official Name | DR. SRILAKSHMI MAGULURI (OWNER) |
| Authorized Official Telephone | 7736772962 |
| Authorized Official Credential | MD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QS0132X |
Clinic/Center Specialization: Ophthalmologic Surgery |
036.118718 | IL | Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IN | 036.118718 | 05 |
| Street Address |
850 W IRVING PARK RD |
| City | CHICAGO |
| State | IL |
| Zip Code | 60613-3077 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1700879434 | Ricardo Machado | Internal Medicine | 850 W Irving Park Rd, Suite 102, Chicago, IL 60613-3077 | 2005-08-29 |
| 1790385987 | Adebowale Oyebamiji | Nurse Practitioner | 850 W Irving Park Rd, Chicago, IL 60613-3077 | 2020-10-28 |
| 1396350955 | Thorek Memorial Hospital | Clinic/Center | 850 W Irving Park Rd, Chicago, IL 60613-3077 | 2020-09-10 |
| 1003435868 | Jun Phan | Dietitian, Registered | 850 W Irving Park Rd, Chicago, IL 60613-3077 | 2020-04-13 |
| 1124670948 | Bukola Eunice Odusote | Nurse Practitioner | 850 W Irving Park Rd, Chicago, IL 60613-3077 | 2019-07-11 |
| 1508332552 | Virgilio A Caramay | Nurse Practitioner | 850 W Irving Park Rd, Chicago, IL 60613-3077 | 2018-10-17 |
| 1457845505 | Alison Casie Chruscinski | Social Worker | 850 W Irving Park Rd, Chicago, IL 60613-3077 | 2018-06-20 |
| 1821591058 | Sarah Grace Perkins | Dietitian, Registered | 850 W Irving Park Rd, Chicago, IL 60613-3077 | 2018-03-14 |
| 1790288868 | Lakeview Health Network LLC | Health Maintenance Organization | 850 W Irving Park Rd, Chicago, IL 60613-3077 | 2018-03-14 |
| 1073020756 | Nanda Kishore Maddineni | Specialist/Technologist, Other | 850 W Irving Park Rd, Chicago, IL 60613-3077 | 2018-01-04 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1588261978 | Thorek Radiology Group Nfp | Radiology | 850 West Irving Park Road, Chicago, IL 60613 | 2020-10-08 |
| 1760034128 | Maryellen Karas Lajeunesse | Social Worker | 3930 N. Pine Grove Ave, #2403, Chicago, IL 60613 | 2019-07-15 |
| 1801366430 | Stephanie A Dykema | Psychologist | 4043 N Ravenswood Ave Suite 302, Chicago, IL 60613 | 2018-11-27 |
| 1487154191 | Alan Tsang | Counselor | 655 W Irving Park Rd Ste 203, Chicago, IL 60613 | 2018-02-19 |
| 1972015782 | Integrated Ortho, LLC. | Durable Medical Equipment & Medical Supplies | 3717 N. Ravenswood Ave, Suite 219w, Chicago, IL 60613 | 2017-11-02 |
| 1073048005 | Claire Jolly | Social Worker | 3701 N Ravenswood Ave Ste 301, Chicago, IL 60613 | 2017-04-27 |
| 1730626011 | Marc Fagan | Psychologist | 4101 N Ravenswood Ave., Chicago, IL 60613 | 2017-01-25 |
| 1205385671 | Sara Turner | Psychologist | 3855 N Greenview Ave # 2a, Chicago, IL 60613 | 2016-09-27 |
| 1962955997 | Michelle Montero | Psychologist | 925 W Dakin St Apt 405, Chicago, IL 60613 | 2016-07-26 |
| 1063883494 | Athletico, Ltd | Physical Therapist | 3922 North Sheridan Rd, Chicago, IL 60613 | 2015-10-12 |
| Find all providers in zip 60613 | ||||
| Taxonomy Code | 261QS0132X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Ophthalmologic Surgery |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1477036671 | Chicago Lasik Center, LLC | Clinic/Center | 405 N Wabash Ave Ste P-2e, Chicago, IL 60611-3591 | 2018-09-13 |
| 1811479058 | Essential Ophthalmology Inc | Clinic/Center | 4646 N Marine Dr Ste A5400, Chicago, IL 60640-5759 | 2018-09-04 |
| 1932742541 | Aghapy LLC | Clinic/Center | 5683 N Milwaukee Ave, Chicago, IL 60646-6220 | 2019-10-26 |
| 1003340415 | Km Williams Md Sc | Clinic/Center | 1725 W Harrison St, Ste 910, Chicago, IL 60612-3841 | 2017-04-12 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1750765012 | Illinois Retina Associates, S.c. | Clinic/Center | 71 W 156th St Ste 400, Harvey, IL 60426-4265 | 2015-07-16 |
| 1023056090 | Gailey Eye Surgery - Decatur, LLC | Clinic/Center | 646 W Pershing Rd, Decatur, IL 62526-1633 | 2006-06-03 |
| 1427698489 | Deseye Retina LLC | Clinic/Center | 15905 S Frederick St Ste 105, Plainfield, IL 60586-2212 | 2020-01-07 |
| 1356897748 | The Cataract Vision Institute LLC | Clinic/Center | 1 Mid America Plz, Suite 250, Oakbrook Terrace, IL 60181-4450 | 2016-08-26 |
| 1184896219 | Nierman Nierman & Nierman | Clinic/Center | 151 Mchenry Rd, Buffalo Grove, IL 60089-1796 | 2008-03-28 |
| 1790983914 | Elmhurst Eye Surgery Center | Clinic/Center | 152 N Addison Ave, Elmhurst, IL 60126-2821 | 2007-07-10 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.