Healthcare Provider Details

I. General information

NPI: 1497949408
Provider Name (Legal Business Name): SHARP VISION INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/02/2007
Last Update Date: 11/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2126A S ARCHER AVE
CHICAGO IL
60616-1514
US

IV. Provider business mailing address

2126A S ARCHER AVE
CHICAGO IL
60616-1514
US

V. Phone/Fax

Practice location:
  • Phone: 312-949-1888
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code305S00000X
TaxonomyPoint of Service
License Number24236918
License Number StateIL

VIII. Authorized Official

Name: WALLACE W CHAN
Title or Position: PRESIDENT
Credential: OD
Phone: 312-949-1888