Healthcare Provider Details

I. General information

NPI: 1801987367
Provider Name (Legal Business Name): ARSENEAU OPTICAL OF KANKAKEE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/27/2006
Last Update Date: 07/03/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

135 W COURT ST
KANKAKEE IL
60901
US

IV. Provider business mailing address

135 W COURT ST
KANKAKEE IL
60901
US

V. Phone/Fax

Practice location:
  • Phone: 815-933-5798
  • Fax: 815-929-5760
Mailing address:
  • Phone: 815-933-5798
  • Fax: 815-929-5760

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code156F00000X
TaxonomyTechnician/Technologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code156FC0800X
TaxonomyContact Lens Technician/Technologist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code156FX1800X
TaxonomyOptician
License Number
License Number State

VIII. Authorized Official

Name: MARY TROST
Title or Position: PRES OPTICIAN
Credential:
Phone: 815-933-5798