Healthcare Provider Details

I. General information

NPI: 1326168378
Provider Name (Legal Business Name): PLYAM OF CHICAGO RIDGE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/30/2007
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 CHICAGO RIDGE MALL
CHICAGO RIDGE IL
60415-2636
US

IV. Provider business mailing address

2305 WILLOW RD
GLENVIEW IL
60025-7637
US

V. Phone/Fax

Practice location:
  • Phone: 708-636-5684
  • Fax:
Mailing address:
  • Phone: 847-832-0073
  • Fax: 847-832-0074

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1800X
TaxonomyOptician
License Number
License Number StateIL

VIII. Authorized Official

Name: MS. TATYANA LALAYAN
Title or Position: GROUP MANAGER OF PEARLE VISION
Credential: BS
Phone: 847-832-0073