Healthcare Provider Details

I. General information

NPI: 1225697675
Provider Name (Legal Business Name): PARK RIDGE VISION LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/10/2019
Last Update Date: 06/10/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 S NORTHWEST HWY STE 104
PARK RIDGE IL
60068-4262
US

IV. Provider business mailing address

350 S NORTHWEST HWY STE 104
PARK RIDGE IL
60068-4262
US

V. Phone/Fax

Practice location:
  • Phone: 847-823-8283
  • Fax: 847-823-1099
Mailing address:
  • Phone: 847-823-8283
  • Fax: 847-823-1099

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code152WS0006X
TaxonomySports Vision Optometrist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code152WV0400X
TaxonomyVision Therapy Optometrist
License Number
License Number State

VIII. Authorized Official

Name: DR. DANIEL PRESS
Title or Position: OWNER
Credential:
Phone: 847-823-8283