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General NPI Number Information
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NPI Number | 1023229440
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Entity Type | Organization
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Legal Business Name | ELITE OPTICAL LOOK DBA PEARLE VISON
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Dates
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Enumeration Date | 05/25/2007
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Last Update Date | 09/07/2007
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Provider Practice Location Address
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Address Line | 410 N MICHIGAN AVE
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City | CHICAGO
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State | IL
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Zip | 60611-4213
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Country | US
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Telephone | 312-644-0885
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Fax | 312-222-1127
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Provider Business Mailing Address
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Address Line | 410 N MICHIGAN AVE
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City | CHICAGO
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State | IL
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Zip | 60611-4213
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Country | US
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Telephone | 312-644-0885
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Fax | 312-222-1127
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Authorized Official
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Title or Position | OWNER
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Name | MRS. GINA LIGHT
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Credential |
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Telephone | 312-644-0885
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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 | 1817003
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License Number State | IL
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