Healthcare Provider Details

I. General information

NPI: 1912339581
Provider Name (Legal Business Name): PROGRESSIVE OPTICAL, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2013
Last Update Date: 08/05/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

704 E RAND RD
ARLINGTON HEIGHTS IL
60004-4006
US

IV. Provider business mailing address

704 E RAND RD
ARLINGTON HEIGHTS IL
60004-4006
US

V. Phone/Fax

Practice location:
  • Phone: 847-259-3933
  • Fax:
Mailing address:
  • Phone: 847-259-3933
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number State

VIII. Authorized Official

Name: MARIANNA BARSKY
Title or Position: O.D.
Credential:
Phone: 847-259-3933