Healthcare Provider Details

I. General information

NPI: 1861823361
Provider Name (Legal Business Name): GALILEO OPTICAL CO.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/09/2013
Last Update Date: 01/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1449 W FULLERTON AVE
CHICAGO IL
60614-8027
US

IV. Provider business mailing address

1449 W FULLERTON AVE
CHICAGO IL
60614-8027
US

V. Phone/Fax

Practice location:
  • Phone: 773-549-2020
  • Fax:
Mailing address:
  • Phone: 773-549-2020
  • 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: SALVATORE ARENELLA
Title or Position: PRESIDENT
Credential:
Phone: 773-549-2020