Healthcare Provider Details
I. General information
NPI: 1265653489
Provider Name (Legal Business Name): BEMARK, INC.
Entity Type: Organization
Gender:
Sole Proprietor:
II. Dates (important events)
Enumeration Date: 05/02/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:
III. Provider practice location address
6560 W FULLERTON AVE SUITE C-118, PEARLE VISION
CHICAGO IL
60707-3439
US
IV. Provider business mailing address
6560 W FULLERTON AVE SUITE C-118, PEARLE VISION
CHICAGO IL
60707-3439
US
V. Phone/Fax
- Phone: 773-745-1767
- Fax: 773-745-0127
- Phone: 773-745-1767
- Fax: 773-745-0127
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 332H00000X |
| Taxonomy | Eyewear Supplier |
| License Number | 1610-4625 |
| License Number State | IL |
VIII. Authorized Official
Name: MR.
JOSHUA
ZAVELOVICH
Title or Position: FRANCHISEE
Credential:
Phone: 773-745-1767