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NPI Code Detail

MEDICARE: ILYAS OPTICAL INC

MEDICARE: ILYAS OPTICAL INC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1332B00000XDurable Medical Equipment & Medical Supplies046007174IL
2152W00000XOptometrist

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1437326808
Entity Type Code : Organization
Provider Name (Legal Business Name) : ILYAS OPTICAL INC
Provider Business Mailing Address
First Line : 1217 W WILSON AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60640-5516
Country : US
Telephone Number : 773-271-5774
Fax Number : 773-271-0741
Provider Business Practice Location Address
First Line : 1217 W WILSON AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60640-5516
Country : US
Telephone Number : 773-271-5774
Fax Number : 773-271-0741
Authorized Official
Title or Position : OWNER/PRESIDENT
Name : DR. DAVID D DEWAARD
Credential : O. D.
Telephone Number : 773-271-5774
Provider Enumeration Date : 05/14/2008
Last Update Date : 03/29/2023

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Directions to “ILYAS OPTICAL INC ” Practice Location

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