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General NPI Number Information
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NPI Number | 1164759080
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Entity Type | Organization
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Legal Business Name | SBLENDORIO VISION CARE INC
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Dates
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Enumeration Date | 11/13/2009
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Last Update Date | 11/09/2010
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Provider Practice Location Address
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Address Line | 9900 RIDGELAND AVE
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City | CHICAGO RIDGE
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State | IL
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Zip | 60415-1241
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Country | US
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Telephone | 708-422-9721
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Fax | 708-422-8955
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Provider Business Mailing Address
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Address Line | 9900 RIDGELAND AVE
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City | CHICAGO RIDGE
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State | IL
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Zip | 60415-1241
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Country | US
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Telephone | 708-422-9721
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Fax | 708-422-8955
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Authorized Official
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Title or Position | OWNER
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Name | DR. MARK S. SBLENDORIO
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Credential | O.D.
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Telephone | 708-422-8955
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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 | 046008381
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License Number State | IL
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