Healthcare Provider Details

I. General information

NPI: 1235489469
Provider Name (Legal Business Name): EYE Q OPTIQUE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2012
Last Update Date: 07/13/2020
Certification Date: 07/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

722 S BUFFALO GROVE RD
BUFFALO GROVE IL
60089-3708
US

IV. Provider business mailing address

722 S BUFFALO GROVE RD
BUFFALO GROVE IL
60089-3708
US

V. Phone/Fax

Practice location:
  • Phone: 847-947-8875
  • Fax: 847-589-1375
Mailing address:
  • Phone: 847-947-8875
  • Fax: 847-589-1375

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code156FX1800X
TaxonomyOptician
License Number
License Number StateIL

VIII. Authorized Official

Name: MISS NARMINA GUSEYNOVA
Title or Position: OWNER
Credential:
Phone: 847-947-8875