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General NPI Number Information
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NPI Number | 1225351471
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Entity Type | Organization
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Legal Business Name | GEL M GOWIN,INC.
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Dates
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Enumeration Date | 03/02/2010
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Last Update Date | 03/02/2010
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Provider Practice Location Address
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Address Line | 3541 W 95TH ST
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City | EVERGREEN PARK
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State | IL
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Zip | 60805-2135
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Country | US
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Telephone | 708-425-4162
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Fax | 708-425-8708
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Provider Business Mailing Address
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Address Line | 3541 W 95TH ST
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City | EVERGREEN PARK
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State | IL
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Zip | 60805-2135
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Country | US
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Telephone | 708-425-4162
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Fax | 708-425-8708
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Authorized Official
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Title or Position | OWNER
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Name | ANGELITA M GOWIN
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Credential |
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Telephone | 708-425-4162
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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 | 37582585
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License Number State | IL
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