| Organization Name: | NORTHWESTERN MEDICAL FACULTY FOUNDATION |
| NPI Number: | 1063821916 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | JUSTIN A. JOHNSON (VP,CFO) |
| Mailing Address: | 900 N Westmoreland Rd Lower Level 88 Lake Forest |
| State: | IL US |
| Postal Code: | 600451674 |
| Phone Number: | 8472950001 |
| Fax Number: | |
| NPI Enumeration Date: | 08/05/2014 |
| NPI Last Update Date: | 11/04/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 152WC0802X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | |
| Taxonomy Type: | Eye and Vision Services Providers |
| Taxonomy Classification: | Optometrist |
| Taxonomy Specialization: | Corneal and Contact Management |
| Taxonomy Definition: | The professional activities performed by an Optometrist related to the fitting of contact lenses to an eye, ongoing evaluation of the cornea |