Healthcare Provider Details

I. General information

NPI: 1376094417
Provider Name (Legal Business Name): CONTACT LENSES UNLIMITED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/24/2016
Last Update Date: 10/24/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3123 N. BROADWAY ST. CONTACT AND SPECS
CHICAGO IL
60657
US

IV. Provider business mailing address

3123 N. BROADWAY ST. CONTACT AND SPECS
CHICAGO IL
60657
US

V. Phone/Fax

Practice location:
  • Phone: 773-880-5400
  • Fax:
Mailing address:
  • Phone: 773-880-5400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code152WX0102X
TaxonomyOccupational Vision Optometrist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code156FC0800X
TaxonomyContact Lens Technician/Technologist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code156FC0801X
TaxonomyContact Lens Fitter
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code156FX1800X
TaxonomyOptician
License Number
License Number State

VIII. Authorized Official

Name: MRS. TONYA WHITE
Title or Position: BILLING CONSULTANT
Credential:
Phone: 773-512-4306