Healthcare Provider Details

I. General information

NPI: 1740006402
Provider Name (Legal Business Name): IDOL EYES FRANCHISE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/27/2024
Last Update Date: 11/27/2024
Certification Date: 11/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4104 N HARLEM AVE STE 32B
NORRIDGE IL
60706-1244
US

IV. Provider business mailing address

4104 N HARLEM AVE STE 32B
NORRIDGE IL
60706-1244
US

V. Phone/Fax

Practice location:
  • Phone: 866-866-7215
  • Fax:
Mailing address:
  • Phone: 866-866-7215
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: ELIZABETH PORIKOS-GORGEES
Title or Position: PRESIDENT
Credential:
Phone: 866-866-7215