MEDICARE: ASSOCIATES IN OPTOMETRY

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
1	152W00000X	Optometrist		IL

General Provider Information

NPI Number	:	1437341112
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ASSOCIATES IN OPTOMETRY

Provider Business Mailing Address
First Line	:	4744 W PETERSON AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60646-5706
Country	:	US
Telephone Number	:	773-736-2800
Fax Number	:	773-736-2802

Provider Business Practice Location Address
First Line	:	4744 W PETERSON AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60646-5706
Country	:	US
Telephone Number	:	773-736-2800
Fax Number	:	773-736-2802

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. GEORGE PAWLYK
Credential	:
Telephone Number	:	773-736-2800

Provider Enumeration Date	:	08/15/2007
Last Update Date	:	09/13/2007

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