Healthcare Provider Details

I. General information

NPI: 1356117501
Provider Name (Legal Business Name): OGDEN VISON CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/29/2023
Last Update Date: 11/29/2023
Certification Date: 11/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

941 OGDEN AVE
DOWNERS GROVE IL
60515-2828
US

IV. Provider business mailing address

5501 W PLAINFIELD RD
COUNTRYSIDE IL
60525-3591
US

V. Phone/Fax

Practice location:
  • Phone: 708-482-7744
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: SAMIR PATEL
Title or Position: MEMBER
Credential: OD
Phone: 708-482-7744