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General NPI Number Information
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NPI Number | 1235668245
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Entity Type | Organization
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Legal Business Name | VISION MAN
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Dates
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Enumeration Date | 06/05/2017
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Last Update Date | 06/05/2017
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Provider Practice Location Address
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Address Line | 8335 GRAND AVE
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City | RIVER GROVE
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State | IL
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Zip | 60171-1434
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Country | US
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Telephone | 708-453-5900
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Fax |
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Provider Business Mailing Address
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Address Line | 8335 GRAND AVE
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City | RIVER GROVE
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State | IL
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Zip | 60171-1434
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OD
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Name | DR. INNA GOLDBERG
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Credential |
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Telephone | 847-607-8189
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 156FX1800X
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Taxonomy Name | Optician
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License Number |
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License Number State |
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