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General NPI Number Information
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NPI Number | 1013192301
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Entity Type | Organization
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Legal Business Name | EYE MAGIC INC
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Dates
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Enumeration Date | 01/04/2008
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Last Update Date | 09/26/2008
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Provider Practice Location Address
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Address Line | 605 ELM PLACE
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City | HIGHLAND PARK
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State | IL
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Zip | 60035
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Country | US
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Telephone | 847-433-9116
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Fax | 847-433-1829
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Provider Business Mailing Address
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Address Line | 605 ELM PLACE
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City | HIGHLAND PARK
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State | IL
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Zip | 60035
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Country | US
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Telephone | 847-433-9116
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Fax | 847-433-1829
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Authorized Official
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Title or Position | PRESIDENT
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Name | MRS. MARLA SUE DIAMOND
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Credential |
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Telephone | 847-433-9116
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number |
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License Number State |
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