Healthcare Provider Details

I. General information

NPI: 1295885572
Provider Name (Legal Business Name): COLE VISION CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/11/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

265 S IL ROUTE 83
ELMHURST IL
60126-3019
US

IV. Provider business mailing address

265 S IL ROUTE 83
ELMHURST IL
60126-3019
US

V. Phone/Fax

Practice location:
  • Phone: 630-833-0177
  • Fax: 630-833-0339
Mailing address:
  • Phone: 630-833-0177
  • Fax: 630-833-0339

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number State

VIII. Authorized Official

Name: MS. WENDY UHLS
Title or Position: MEDICARE SUPERVISOR
Credential:
Phone: 513-765-3534