Healthcare Provider Details

I. General information

NPI: 1649443391
Provider Name (Legal Business Name): AFFORDABLE OPTICAL CHICAGO INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/02/2008
Last Update Date: 04/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6560 NORTH SHERIDAN RD
CHICAGO IL
60626
US

IV. Provider business mailing address

6560 NORTH SHERIDAN RD
CHICAGO IL
60626
US

V. Phone/Fax

Practice location:
  • Phone: 773-274-2020
  • Fax: 773-274-6121
Mailing address:
  • Phone: 773-274-2020
  • Fax: 773-274-6121

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License NumberGBL2008124
License Number StateIL

VIII. Authorized Official

Name: MRS. INNA AZRIKAN
Title or Position: PRESIDENT
Credential:
Phone: 847-707-9718