Healthcare Provider Details

I. General information

NPI: 1336505908
Provider Name (Legal Business Name): OXIE AFFORDABLE OPTICAL PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/12/2016
Last Update Date: 07/17/2025
Certification Date: 07/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

908C N LAKE ST
AURORA IL
60506-2550
US

IV. Provider business mailing address

908C N LAKE ST
AURORA IL
60506-2550
US

V. Phone/Fax

Practice location:
  • Phone: 630-692-9220
  • Fax:
Mailing address:
  • Phone: 630-692-9220
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number4970
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: MIA B CORRIEA
Title or Position: OPTICIAN
Credential:
Phone: 630-692-9220