MEDICARE: EYES ON FULTON LLC

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	046009874	IL

Other Identifiers

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

General Provider Information

NPI Number	:	1750747721
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EYES ON FULTON LLC

Provider Business Mailing Address
First Line	:	1011 W FULTON MARKET
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60607-1222
Country	:	US
Telephone Number	:	312-226-2020
Fax Number	:	312-226-2021

Provider Business Practice Location Address
First Line	:	1011 W FULTON MARKET
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60607-1222
Country	:	US
Telephone Number	:	312-226-2020
Fax Number	:	312-226-2021

Authorized Official
Title or Position	:	PRESIDENT
Name	:	KAORI ASANO
Credential	:	O.D.
Telephone Number	:	310-903-0908

Provider Enumeration Date	:	01/06/2016
Last Update Date	:	01/06/2016

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Directions to “EYES ON FULTON LLC ” Practice Location

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