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General NPI Number Information
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NPI Number | 1013206531
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Entity Type | Organization
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Legal Business Name | GITTELE OPTICAL INC.
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Dates
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Enumeration Date | 04/05/2011
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Last Update Date | 04/05/2011
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Provider Practice Location Address
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Address Line | 3455A DEMPSTER ST
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City | SKOKIE
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State | IL
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Zip | 60076-2455
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Country | US
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Telephone | 847-322-9613
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Fax | 847-368-9920
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Provider Business Mailing Address
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Address Line | 3455A DEMPSTER ST
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City | SKOKIE
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State | IL
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Zip | 60076-2455
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Country | US
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Telephone | 847-322-9613
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Fax | 847-368-9920
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Authorized Official
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Title or Position | OPTOMETRIST
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Name | DR. EUGENIA LAMAZOV
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Credential | O.D.
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Telephone | 847-322-9613
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 046008934
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License Number State | IL
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